Letter to the Editor
(2026) Digestive Endoscopy — Vol. 38, n° 5, p. e70176 (2026)
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- Abstract
- We read with great interest the manuscript by Ota et al. on the comparison of enteroscopy-assisted ERP-guided (eERP-PDD) versus EUS-guided pancreatic duct drainage (EUS-PDD) for surgical pancreaticojejunostomy strictures [1]. Data were collected in 13 Japanese centers including 111 procedures in 88 patients, of whom 77 underwent initial eERP-PDD and 11 EUS-PDD. Per-patient analysis resulted in better technical (73% vs. 42%) and clinical (73% vs. 40%) outcomes of the 11 EUS-PDD procedures, with however higher adverse event (AE) rates (27% vs. 5%). The authors' conclusion stated that eERP-PDD should be reserved for pancreatic duct drainage with a diameter of < 5 mm. First-line EUS-PDD is indicated when the pancreatic duct exceeds 5 mm and in second line after failed eERP-PDD. Although we generally agree with the proposed algorithm, we were surprised by the low eERP-PDD technical success rate in this multicenter study. We recently published our single-center results of single-balloon enteroscopy-assisted ERCP in patients with Whipple's pancreaticoduodenectomy including 46 patients of whom 17 underwent pancreatic duct drainage [2]. Technical and clinical success were 80% and 65%, which is close to the EUS-PDD results of the Ota et al. study. The authors did not mention which catheters were used to attempt pancreatic duct cannulation (straight catheter, sphincterotome, injection needle , etc.) neither the use of a transparent cap, which all represent important factors impacting technical success of the eERP-PDD procedures [2]. Moreover, the higher AE rate of EUS-PDD procedures (27% vs. 5%) was concealed using propensity score adjustment (29% vs. 7%) losing statistical significance, however, still representing a clinically relevant difference in real life [1]. These different endoscopic approaches to the pancreatic duct represent complementary rather than competitive techniques with their respective advantages and shortcomings. They should be selected on a case-by-case basis with the shared goal of optimized patient outcome.
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Citations
Moreels, T. G., Deprez, P. H., & Piessevaux, H. (2026). Letter to the Editor. Digestive Endoscopy, 38(5), e70176. https://doi.org/10.1111/den.70176 (Original work published 2026)