[Background] Malignant pancreatic strictures with acute pancreatitis are rare but sometimes occur in cases with pancreatic cancers. Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) has emerged as a salvage procedure where endoscopic retrograde cholangiopancreatography (ERCP) fails or is difficult. We report two cases of acute pancreatitis associated with pancreatic cancer successfully managed by EUS-PDD.
[Case 1] An 81-year-old woman was diagnosed with pancreatic head carcinoma with duodenal invasion and multiple pulmonary metastases. She underwent percutaneous biliary drainage with a fully covered metal stent, followed by nab-paclitaxel plus gemcitabine was administered. Four months after initiation of chemotherapy, EUS-guided hepaticogastrostomy was performed because of biliary stent obstruction. One month later, she developed acute pancreatitis with pancreatic fluid collection. Since transpapillary pancreatic duct stenting was unsuccessful due to duodenal stricture of the second part, EUS-PDD was performed with a 7Fr plastic stent. Pancreatitis was promptly resolved.
[Case 2] An 87-year-old woman was diagnosed with locally advanced pancreatic head carcinoma and received single-agent gemcitabine. Three months after the initiation of therapy, she underwent duodenal stenting as a result of stricture of the third part. One month later, she developed acute pancreatitis with pancreatic fluid collection, and ERCP was performed. Because a guidewire did not advance over the main pancreatic duct stricture, transpapillary pancreatic duct stenting was unsuccessful. EUS-PDD was performed using a 7Fr plastic stent. Bacteriological examination of the aspirated pancreatic juice revealed Klebsiella pneumoniae. Acute obstructive suppurative pancreatic ductitis was promptly resolved after EUS-PDD. No complications occurred in any of the two cases.
[Conclusions] EUS-PDD is a promising approach as a palliative treatment for obstructive pancreatitis associated with pancreatic cancer.