Resolution of pancreatic ductal disruption through endoscopic ultrasound (EUS)-guided Rendez-vous in a patient with pancreas divisum.

A 73-year-old woman presented with a pancreas divisum was admitted for acute pancreatitis. Abdominal CT was performed due to a torpid evolution with fever and oral intolerance, demonstrating necrosis and ductal disruption in the pancreatic neck. An ERCP was attempted, however, the minor papilla (MP) could not be identified because of the presence of edematous duodenal folds.

Percutaneous transhepatic or endoscopic ultrasound-guided biliary drainage in malignant distal bile duct obstruction using a self-expanding metal stent: Study protocol for a prospective European multicenter trial (PUMa trial).

Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) was associated with better clinical success and a lower rate of adverse events (AEs) than fluoroscopy-guided percutaneous transhepatic biliary drainage (PTBD) in recent single center studies with mainly retrospective design and small case numbers (< 50). The aim of this prospective European multicenter study is to compare both drainage procedures using ultrasound-guidance and primary metal stent implantation in patients with malignant distal bile duct obstruction (PUMa Trial).

Methods: The study is designed as a non-randomized, controlled, parallel group, non-inferiority trial.