A USEFUL PROCEDURE EMPLOYING A DOUBLE BALLOON ENDOSCOPE WITH A BALLOON CATHETER FOR RECURRENT PANCREATITIS DUE TO STENOSIS OF A PANCREATIC DUCTAL ANASTOMOSIS : A CASE REPORT

概要

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A 73-year-old man underwent pancreatoduodenectomy for an intraductal papillary mucinous neoplasm in the region between the pancreatic head and body in 2008. The pathological diagnosis was intraductal papillary-mucinous adenoma with mild atypia. Thereafter, he was admitted to our hospital four times between February and August 2011 because of pancreatitis and acute abdominal pain, and was treated conservatively on each occasion. After the third admission in May 2011, we considered it necessary to observe the anastomosis of the pancreatojejunostomy directly with a double balloon endoscope (DBE). However, the attempt was abandoned because of difficulty in locating the anastomosis. After the fourth admission in August 2011, we conducted DBE again. Although we again had trouble finding the anastomosis, we finally succeeded with the assistance of a balloon catheter. We enlarged the catheter balloon at the tip of the endoscope and obtained a view range that allowed observation of the mucous membrane through the balloon. We were able to complete the treatments, which involved dilation of the stenosis and removal of a pancreatic stone, following pancreatography. The patient has since been free of symptoms or relapse of pancreatitis. In a case of this kind, where there is a problem identifying the anastomosis of a pancreatojejunostomy due to anastomotic stricture or a limited field of view, this method is considered to be very useful.