Table 6

Consensus statements on the optimal management of endoscopic ultrasonography-guided pancreatic duct (EUS-PD) drainage

StatementsFinal level of agreementEvidence level
Indications for the procedure
1 EUS-PD is recommended in patients with pancreatic duct obstruction after failed ERCPAppropriate (8.0)Moderate
2 EUS-PD is recommended in patients with pancreatic duct obstruction and surgically altered anatomy or duodenal stenosis where ERCP is not possibleAppropriate (9.0)Moderate
Optimal approach for drainage
3 EUS-PD could be achieved by the rendezvous technique, pancreatico-gastrostomy and antegrade drainageAppropriate (8.0)Moderate
4 The transgastric approach should be used as the initial approach for EUS-PDAppropriate (8.0)Low
Pre-drainage evaluation
5 Appropriate imaging including MRCP or CECT is recommended in patients with obstruction of the main pancreatic duct prior to EUS-PDAppropriate (9.0)Very Low
Pre-procedural preparations
6 Antibiotic prophylaxis is recommended before the EUS-PD procedureAppropriate (8.0)Very Low
Procedural considerations
7 Following pancreatic duct puncture with a 19-gauge needle, a 0.035 inch or 0.025 inch guidewire with floppy tip is recommended to be used to negotiate the pancreatic duct and the papillaAppropriate (9.0)Very Low
8 Catheters, dilators, cystotomes or balloons are recommended for track dilationAppropriate (9.0)Very Low
9 Plastic stents without intervening side holes between the ends of the stent are recommended for EUS-PDAppropriate (8.0)Low
Management of complications
10 Multidisciplinary support including interventional radiologist, surgeons and anaesthesiologist are recommended in centres performing the procedure to prevent and manage complications as complication rates of EUS-PD are higher than ERCPAppropriate (9.0)Low
Competency and training
11 EUS-PD should be done at expert centres with facilities and expertise in interventional EUS and advanced ERCPAppropriate (9.0)Very Low
12 EUS-PD should be performed by experienced endoscopists in EUS and EUS-FNA, wire manipulation techniques and stent placementAppropriate (9.0)Very Low
  • CECT, contrast-enhanced computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; FNA, fine needle aspiration; MRCP, magnetic resonance cholangiopancreatography.