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DOI: 10.1055/a-2589-0654
Forward-viewing echoendoscope-guided pancreaticojejunostomy for post-pancreaticoduodenectomy stricture

Pancreaticojejunal anastomotic strictures (PJAS) and pancreatic fluid leakage can occur after pancreaticoduodenectomy [1] [2]. Treatments include endoscopic retrograde pancreatography using a balloon enteroscope or transgastric endoscopic ultrasound (EUS)-guided procedures [2] [3]. These treatments can be challenging in patients with severe or complete anastomotic obstruction. Alternatively, EUS-guided pancreaticojejunostomy (EUS-PJS) allows direct access to the pancreatic duct [4], and a forward-viewing echoendoscope (FV-EUS; TGF-UCT260J; Olympus Medical Systems) expands the field of view, facilitating the precise identification of and access to the anastomotic site [4]. Herein, we describe our experience implementing EUS-PJS.
A 76-year-old man presented with PJAS and pancreatic fluid leakage 8 months after pancreaticoduodenectomy ([Fig. 1]). Endoscopic treatment was planned, but single-balloon enteroscopy could not identify the pancreaticojejunostomy site. An EUS-guided rendezvous technique ([Fig. 2] a) was attempted, but neither a guidewire (GW) nor contrast medium could pass through the pancreaticojejunostomy site; both advanced into the pancreatic fluid leakage area ([Fig. 2] b, c). Transgastric EUS-guided drainage was performed for pancreatic fluid leakage on the same day ([Fig. 2] d). Subsequently, EUS-PJS was performed using FV-EUS ([Fig. 3], [Video 1]), which was advanced to the pancreaticojejunostomy site. The pancreatic duct was identified using EUS, punctured with a 19 G needle (EZ shot3; Olympus Medical Systems), and confirmed with contrast medium ([Fig. 4] a), then a 0.025-inch GW was inserted ([Fig. 4] b). The double-GW technique was employed due to significant angulation of the pancreatic duct, and dilation was performed using a drill-type dilator ([Fig. 4] c). A double-lumen catheter was inserted while retaining 0.035 inches of GW in the pancreatic duct ([Fig. 4] d). A 3-mm balloon dilator was used to dilate the pancreaticojejunostomy site ([Fig. 4] e). A 7Fr 5-cm plastic stent was placed to complete the procedure ([Fig. 4] f). Postoperative adverse events did not occur. EUS-PJS can treat PJAS if balloon enteroscopy or a transgastric EUS-guided approach is unsuccessful.








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Publication History
Article published online:
09 May 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
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- 3 Imoto A, Ogura T, Higuchi K. Endoscopic ultrasound-guided pancreatic duct drainage: techniques and literature review of transmural stenting. Clin Endosc 2020; 53: 525-534
- 4 Sadek A, Hara K, Okuno N. et al. Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan. Epub ahead of print.. Clin Endosc 2024;