Review of indication stratification and clinical strategies for endoscopic ultrasound-guided pancreatic duct drainage

doi:10.3969/j.issn.1674-8115.2026.07.003

Abstract

Abstract:

Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD/EUS-PDD) represents a major advancement in therapeutic endoscopy for pancreatic duct disorders. It is primarily indicated for patients with symptomatic pancreatic duct obstruction in whom endoscopic retrograde pancreatography (ERCP) has failed or is not feasible. The procedure involves transmural puncture of the main pancreatic duct via the stomach, duodenum, or postsurgical jejunal limb, followed by guidewire placement, tract dilation, and stent insertion to achieve ductal decompression and restoration of pancreatic juice drainage. Systematic reviews and meta-analyses have reported an overall technical success rate of 84.8%, a clinical success rate of 89.2%, and an overall adverse event rate of 18.1%, indicating substantial efficacy with non-negligible risks. The common indications for EUS-PD include pancreatic duct disruption due to pancreatic trauma, pancreatic duct injury associated with pancreatic surgery, pancreatic duct disruption secondary to severe acute pancreatitis, and surgically altered anatomy. Complications mainly include post-procedural pancreatitis, bleeding, perforation, and stent-related dysfunction. This review constructs an evidence chain covering indication stratification, procedural approaches, key techniques, complication management, long-term follow-up, and reintervention strategies, aiming to provide a reproducible clinical decision-making framework for the implementation of EUS-PD in endoscopic centers in China.

Key words: endoscopic ultrasound, pancreatic duct drainage, chronic pancreatitis, surgically altered anatomy, endoscopic ultrasound-guided rendezvous

CLC Number:

R445.1

Chang Yuxin, Li Baiwen, Ni Jianbo. Review of indication stratification and clinical strategies for endoscopic ultrasound-guided pancreatic duct drainage[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(7): 847-856.

Figures/Tables 4

TrendMD

References 71

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Reference	Study design	n	Indication	Approach	TS/%	CS/%	FU/ month	Migration/Occlusion	Reintervention	Overall AE/%
François^[10] (2002)	Case series	4	MPD obstruction, pain	TMD	100.0	75.0	12.0	NR	NR	0
Matsunami^[40] (2018)	Single-center	30	ARP, PJAS, MPD stricture	TMD	83.3	92.0	23.0^①	24.0%	Median 3^②	NR
Falque^[41] (2021)	Single-center	27	CP or SAA	TMD	92.5	88.8	34.2^①	18.5%	7.4%	NR
Chandan^[49] (2020)	Meta-analysis	714	Mixed cohort	RV+TMD	84.8	89.2	Var	21.3%	15.2%	18.1
Tyberg^[50] (2020)	Operator cohort	56	Mixed cohort	RV+TMD	84.0	98.0	13.0^①	3.6%	3.6%	24.0
Tessier^[54] (2007)	Case series	36	CP, MPD dilation	TMD	92.0	69.0	14.5	NR	NR	14.0
Brauer^[55] (2009)	Case series	8	MPD obstruction	TMD	88.0	50.0	14.0	NR	NR	0
Barkay^[56] (2010)	Retrospective	21	Complex MPD disease	TMD	48.0	12.0	13.0	NR	NR	13.0

Reference	Study design	n	Indication	Approach	TS/%	CS/%	FU/ month	Migration/Occlusion	Reintervention	Overall AE/%
François^[10] (2002)	Case series	4	MPD obstruction, pain	TMD	100.0	75.0	12.0	NR	NR	0
Matsunami^[40] (2018)	Single-center	30	ARP, PJAS, MPD stricture	TMD	83.3	92.0	23.0^①	24.0%	Median 3^②	NR
Falque^[41] (2021)	Single-center	27	CP or SAA	TMD	92.5	88.8	34.2^①	18.5%	7.4%	NR
Chandan^[49] (2020)	Meta-analysis	714	Mixed cohort	RV+TMD	84.8	89.2	Var	21.3%	15.2%	18.1
Tyberg^[50] (2020)	Operator cohort	56	Mixed cohort	RV+TMD	84.0	98.0	13.0^①	3.6%	3.6%	24.0
Tessier^[54] (2007)	Case series	36	CP, MPD dilation	TMD	92.0	69.0	14.5	NR	NR	14.0
Brauer^[55] (2009)	Case series	8	MPD obstruction	TMD	88.0	50.0	14.0	NR	NR	0
Barkay^[56] (2010)	Retrospective	21	Complex MPD disease	TMD	48.0	12.0	13.0	NR	NR	13.0