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Percutaneous Image-Guided Pancreatic Duct Drainage: Technique, Results and Expected Benefits

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Abstract

Purpose

The aim of this study is to provide a technical detail and feasibility of percutaneous image-guided pancreatic duct (PD) drainage and to discuss its subtleties in a series of patients with obstructed PD.

Materials and Methods

Thirty patients presenting with PD obstruction from pancreatic head tumour or pancreatitis were subjected to percutaneous image-guided PD drainage under a guidance of ultrasound or computed tomography. Following the successful puncture of PD, a locking loop drainage catheter was placed using conventional guidewire techniques under real-time fluoroscopy guidance.

Results

The percutaneous drainage of obstructed PD was completed in 29 (96.7%) patients as an independent therapeutic intent or as a bridge to further percutaneous procedures. Clinical improvement following drainage was documented by the gradual reduction in clinical symptoms, including pain, nausea and fever and improved blood test results, showing the significant decrease of amylase concentration. The amount of pancreatic fluid drained post procedure was between 300 and 900 mL/day. No major procedure-related complications were observed. Subsequently, 14 of 29 patients underwent further procedures, including endoluminal placement of metal stent with or without radiofrequency ablation, balloon assisted percutaneous descending litholapaxy (BAPDL), endoluminal biopsy and balloon dilatation using the same drainage tract.

Conclusion

The percutaneous PD drainage appears to be a safe and effective procedure. It should be considered in patients with obstructed PD secondary to malignancy, pancreatitis etc., where endoscopic retrograde cannulation has been failed or impracticable. The procedure can also be contemplated either as an independent treatment option or as an initial step for the subsequent therapeutic endoluminal procedures.

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Abbreviations

AP:

Acute pancreatitis

BAPDL:

Balloon assisted percutaneous descending litholapaxy

CBD:

Common bile duct

CT:

Computed tomography

ERCP:

Endoscopic retrograde cholangiopancreatography

EUS:

Endoscopic ultrasound

PD:

Pancreatic duct

RFA:

Radiofrequency ablation

US:

Ultrasound

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Authors and Affiliations

  1. Department of Radiology, Tbilisi State Medical University (TSMU), Tbilisi, Georgia

    M. Mizandari & T. Azrumelashvili

  2. Department of Surgery and Cancer, Imperial College London, London, UK

    J. Kumar & N. Habib

  3. High Technology Medical Center - University Clinic, 9, Tsinandali St., 0144, Tbilisi, Georgia

    M. Mizandari

Authors
  1. M. Mizandari
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  2. T. Azrumelashvili
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  3. J. Kumar
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Correspondence to M. Mizandari.

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Conflict of interest

M. Mizandari, T. Azrumelashvili, and J. Kumar has no conflict of interest; N. Habib has shares in EMcision Limited that developed EndoHPB device.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mizandari, M., Azrumelashvili, T., Kumar, J. et al. Percutaneous Image-Guided Pancreatic Duct Drainage: Technique, Results and Expected Benefits. Cardiovasc Intervent Radiol 40, 1911–1920 (2017). https://doi.org/10.1007/s00270-017-1727-9

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  • DOI: https://doi.org/10.1007/s00270-017-1727-9

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