ENDOSCOPIC BALLOON DILATATION USING A SHORT SINGLE- BALLOON ENTEROSCOPE IN A PATIENT WITH AN ANASTOMOTIC STRICTURE AFTER PANCREATICODUODENECTOMY FOR INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM : A CASE REPORT

Abstract

A 53-year-old woman had undergone pancreaticoduodenectomy (SSPPD-IIA) for an intraductal papillary mucinous neoplasm (IPMN) in November 2009. Nineteen months after the surgery, abdominal CT showed a dilated remnant main pancreatic duct and a small soft tissue density mass. Findings suggested a pancreaticojejunal anastomosis stricture or a recurrent IPMN. Subsequently, the patient was admitted to our hospital with acute pancreatitis. We tried to observe the pancreaticojejunal anastomosis using a prototype short single-balloon enteroscope (Short SBE). However, the first attempt at ERCP was unsuccessful due to difficulty in finding the anastomotic site. In a second attempt 25 months after the surgery it was possible to find the anastomosis using a Short SBE with a transparent hood. We performed balloon dilatation of the anastomotic stricture and removed white protein plugs. The filling defects in the main pancreatic duct disappeared following pancreatography, and it was decided that there was no apparent tumor recurrence. During the following 14 months, no recurrence of the IPMN or pancreatitis has occurred. ERCP using Short SBE is a useful option for the management of a pancreaticojejunal anastomosis stricture.