Therapeutic pancreatic endoscopy after Whipple resection requires rendezvous access

Chronic pancreatic complications after pancreaticoduodenectomy, including strictured pancreaticojejunostomy and pancreatic fistulas, may be amenable to endoscopic therapy. To date there is no published series focusing on pancreatic endotherapy in this group of patients. We report our experience performing pancreatic therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in 10 patients after pancreaticoduodenectomy. All patients had evidence of pancreatic anastomotic obstruction by endoscopic ultrasound (EUS) or secretin-enhanced magnetic resonance cholangiopancreatography. Technical endoscopic success and clinical outcomes were measured. Technically successful endoscopic access and therapy was ultimately achieved by ERCP in eight of the 10 patients. Although a duodenoscope or pediatric colonoscope could be advanced up the afferent limb in all patients, initial unassisted pancreatic cannulation and therapy was successful in only one patient. Rendezvous techniques, either percutaneous or EUS-guied, were required for endoscopic access in the other 9 patients. Complications included moderate pancreatitis with retroperitoneal air after percutaneous rendezvous access in 1 patient, and fever in 1 patient. Therapeutic pancreatic ERCP for chronic complications afterWhipple pancreaticoduodenectomy is feasible but quite challenging. Endoscopic access through a stenotic pancreaticojejunal anastomosi generally requires either EUS or percutaneous rendezvous assistance.