EUS pancreatic rendezvous to rescue failed ERCP for postoperative pancreatic fistula after pancreaticoduodenectomy.

Background and Aims: Postoperative pancreatic fistula (POPF) is a highly morbid adverse event after pancreatic surgery that occurs in up to 25% to 30% of patients. Clinically significant POPFs (grades B and C) often require a step-up approach with percutaneous and endoscopic interventions. Alternative strategies such as EUS-guided rendezvous are helpful when large pancreatojejunostomy dehiscence prevents conventional endoscopic retrograde pancreatography. Methods: We present a series of 3 consecutive patients with clinically significant POPFs after the Whipple procedure in whom there was an unsuccessful percutaneous and conventional endoscopic retrograde pancreatography drainage. The median age of the patients was 62 years, their median body mass index was 40, and median pancreatic duct diameter was 2 mm. Results: EUS-guided pancreatic rendezvous was performed in all cases. The median time from surgery to EUS-guided rendezvous was 28 days. Percutaneous drains were removed after a median of 20 days postprocedure. The mean stent dwell time was 123.6 days. There were no early or delayed adverse events. On median follow-up of 33 months, there were no recurrences recorded. Conclusions: EUS-guided pancreatic rendezvous is a viable rescue strategy for patients with POPFs who do not respond to traditional percutaneous and endoscopic therapy. Further studies are needed.