Consensus statements on the optimal management of endoscopic ultrasonography-guided pancreatic duct (EUS-PD) drainage
| Statements | Final level of agreement | Evidence level | |
| Indications for the procedure | |||
| 1 | EUS-PD is recommended in patients with pancreatic duct obstruction after failed ERCP | Appropriate (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 possible | Appropriate (9.0) | Moderate |
| Optimal approach for drainage | |||
| 3 | EUS-PD could be achieved by the rendezvous technique, pancreatico-gastrostomy and antegrade drainage | Appropriate (8.0) | Moderate |
| 4 | The transgastric approach should be used as the initial approach for EUS-PD | Appropriate (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-PD | Appropriate (9.0) | Very Low |
| Pre-procedural preparations | |||
| 6 | Antibiotic prophylaxis is recommended before the EUS-PD procedure | Appropriate (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 papilla | Appropriate (9.0) | Very Low |
| 8 | Catheters, dilators, cystotomes or balloons are recommended for track dilation | Appropriate (9.0) | Very Low |
| 9 | Plastic stents without intervening side holes between the ends of the stent are recommended for EUS-PD | Appropriate (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 ERCP | Appropriate (9.0) | Low |
| Competency and training | |||
| 11 | EUS-PD should be done at expert centres with facilities and expertise in interventional EUS and advanced ERCP | Appropriate (9.0) | Very Low |
| 12 | EUS-PD should be performed by experienced endoscopists in EUS and EUS-FNA, wire manipulation techniques and stent placement | Appropriate (9.0) | Very Low |
CECT, contrast-enhanced computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; FNA, fine needle aspiration; MRCP, magnetic resonance cholangiopancreatography.