EUS-guided Pancreatic Duct Drainage
Stent selection: Plastic stent (straight/pigtail), fully covered metal stent
To position the scope, identify proper dilated main pancreatic duct with good position. Scope direction to pancreatic head in stable position (transgastric or transduodenal). Short distance as much as possible with negative Doppler signal.
Puncture with 19G FNA needle fi lled with saline or contrast. Check vessel, intervene with Doppler. 22G needle may be required for thin ducts.
Select good wire: fl oppy angled tip with stiff sharp. Slowly manipulate the wire towards pancreatic head direction. Use torque and avoid shearing.
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