# Endoscopic Ultrasound-Guided Pancreaticogastrostomy for Pancreatic Duct Stricture in a Patient With Ansa Pancreatica

## TL;DR

A 59-year-old woman with a pancreatic duct stricture was successfully treated using a stepwise endoscopic approach, avoiding surgery.

## Contribution

This case demonstrates a novel endoscopic strategy for managing pancreatic duct stricture in patients with ansa pancreatica.

## Key findings

- Endoscopic ultrasound-guided pancreaticogastrostomy enabled minor papilla cannulation and pancreatic duct stenting.
- The patient remained asymptomatic with resolution of ductal and peripancreatic abnormalities after treatment.
- The approach avoided surgical intervention and achieved durable transpapillary drainage.

## Abstract

Necrotizing pancreatitis can lead to challenging complications such as pancreatic duct stricture and pancreatic duct disruption. We report a 59-year-old woman with pancreatic ductal stricture causing pancreatic duct leak, initially managed with endoscopic ultrasound-guided pancreaticogastrostomy (PG) after failed transpapillary access due to ansa pancreatica. At follow-up, the PG stent enabled minor papilla cannulation and successful pancreatic duct stenting. The PG stent was removed, and durable transpapillary drainage was achieved. The patient remained asymptomatic with resolution of ductal and peripancreatic abnormalities. This case highlights a minimally invasive, stepwise endoscopic approach for complex ductal anatomy in necrotizing pancreatitis, avoiding surgical intervention.