Percutaneous transluminal angioplasty balloons for endoscopic ultrasound-guided pancreatic duct interventions.

Background: Endoscopic ultrasound (EUS)-guided main pancreatic duct (PD) access may be used when conventional endoscopic retrograde cholangiopancreatography (ERCP) techniques fail. The use of a percutaneous transluminal angioplasty balloon (PTAB), originally developed for vascular interventions, can be used to facilitate transmural ( e.g. , transgastric) PD access and to dilate high-grade pancreatic strictures.
Aim: To describe the technique, efficacy, and safety of PTABs for EUS-guided PD interventions.
Methods: Patients who underwent EUS with use of a PTAB from March 2011 to August 2021 were retrospectively identified from a tertiary care medical center supply database. PTABs included 3-4 French angioplasty catheters with 3-4 mm balloons designed to use over a 0.018-inch guidewire. The primary outcome was technical success. Secondary outcomes included incidence of adverse events (AEs) and need for early reintervention.
Results: A total of 23 patients were identified (48% female, mean age 55.8 years). Chronic pancreatitis was the underlying etiology in 13 (56.5%) patients, surgically altered anatomy (SAA) with stricture in 7 (30.4%), and SAA with post-operative leak in 3 (13.0%). Technical success was achieved in 20 (87%) cases. Overall AE rate was 26% ( n = 6). All AEs were mild and included 1 pancreatic duct leak, 2 cases of post-procedure pancreatitis, and 3 admissions for post-procedural pain. No patients required early re-intervention.
Conclusion: EUS-guided use of PTABs for PD access and/or stricture management is feasible with an acceptable safety profile and can be considered in patients when conventional ERCP cannulation fails.
Competing Interests: Conflict-of-interest statement: Andrew C Storm is a consultant for Apollo Endosurgery; and received research support from Apollo Endosurgery and Boston Scientific. Ryan J Law is a consultant for ConMed and Medtronic and receives royalties from UpToDate. Bret T Petersen is a consultant for Olympus America and investigator for Boston Scientific and Ambu. Barham K Abu Dayyeh reports consultant roles with Endogenex, Endo-TAGSS, Metamodix, and BFKW; consultant and grant or research support from USGI, Cairn Diagnostics, Aspire Bariatrics, Boston Scientific; speaker roles with Olympus, Johnson and Johnson; speaker and grant or research support from Medtronic, Endogastric solutions; and research support from Apollo Endosurgery and Spatz Medical. Vinay Chandrasekhara is a consultant for Covidien LP, is on the advisory board for Interpace Diagnostics, and is a shareholder in Nevakar, Inc. The remaining authors have no conflicts or funding to disclose.
(©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)