ANTEGRADE PANCREATOSCOPY VIA PANCREATO-GASTROSTOMY: GUIDEWIRE FRAGMENT EXTRACTION AND TOTAL STENOSIS CONFIRMATION

A 52yo man with chronic pancreatitis of unknown origin, with neck stenosis and pancreatic ductal lithiasis. After failure of transpapillary cannulation, a Rendezvous technique is realized. After several tries without success, fragmentation of intrapancreatic guidewire occurs. A transmural drainage (USE-guided pancreatic-gastrostomy) with 2 plastic stents is realized. Then,an antegrade pancreatoscopy via pancreato-gastrostomy (SpyGlass-DSII) is made. Main pancreatic duct dilatation, with no lithiasis but with several parenchymatous calcificacions that cause total ductal stenosis. Guidewire fragment identification and retrieval with spy-basket.Another Rendezvous for a transpapillary conversion is made, without success. A third coaxial plastic stent is placed, optimizing the transmural pancreatic drainage