Brief:
Endoscopic Evaluation and Treatment of Calculous Chronic Pancreatitis-Role of EUS-Endotherapy Interface

Description:

• A 40 yrs male was sent to us for the favor of EUS examination was considered to evaluate the exact etiology of recurrent episodes of acute pancreatitis since many years and so far has taken many opinions but continues to suffer with pancreatic symptoms.
• EUS – MPD appeared dilated (4.5 mm) in the head region with prepapillary narrowing of the MPD and dilated side branches. A small stone and few concrements were seen in the prepapillary portion of the accessory duct.
• Selective cannulation of major papilla, Pacreatogram showed prepapillary narrowing of the MPD and dilated side branches, stone extraction was carried out with balloon catheter.
• Selective cannulation of minor papilla, and minor papilla sphincterotomy with stone extraction was carried out with dormia basket
• 7fr stent each was placed from the major and minor papilla

TAKE HOME MESSAGE

• For recurrent acute pancreatitis EUS evaluation is mandatory. Once the diagnosis of the chronic pancreatitis with pancreatic mapping was done on EUS, immediately Endotherapy was performed and in this case both MPD and accessory pancreatic duct contained stone for which after ductal clearance stents were placed from both major and minor papilla to ensure adequate dilatation of prepapillary narrowing and effective ductal decompression.

Image:

1.Multiple stones seen on EUS

2.Dilated MPD seen In the body of pancreas

3.Selective cannulation of major papilla

4.Pacreatogram showed prepapillary narrowing of the MPD and dilated side branches

5.Stone extraction was carried out with balloon catheter.

6.Selective cannulation of minor papilla

7.Stone extraction was carried out with dormia basket

8.7fr stents were placed in major and minor papilla