EUS-Guided Pancreatic Duct Drainage Case Study: Chronic Pancreatitis Pain Resolved After Failed ERCP, Dr. Vipulroy Rathod, Mumbai
Patient Profile
Patient Name: Mr. Suresh Joshi
Age: 47 years| Gender: Male
Consultant: Dr. Vipulroy Dayanand Rathod
Hospital: Fortis Hospitals Limited, Mulund, Mumbai
Diagnosis: Chronic Pancreatitis with Obstructed Pancreatic Duct, Failed ERCP
Past History: Chronic Pancreatitis (5 years) · Two prior failed ERCP attempts · Recurrent hospital admissions for pain
Patient Background
Mr. Suresh Joshi, a 47-year-old from Pune, Maharashtra, came to Fortis Hospital Mulund after living with debilitating chronic pancreatitis pain for over five years. His pancreatic duct was severely obstructed by strictures and stones, and two previous ERCP attempts at other centres had failed to cannulate the duct. With surgical drainage being suggested as the next option, his family searched for the best Gastroenterologist Mumbai capable of an advanced endoscopic alternative. Dr. Vipulroy Rathod, Director of Gastroenterology at Fortis Mulund and South Asia’s pioneer of Endoscopic Ultrasound with over 20,000 EUS procedures, recommended EUS-Guided Pancreatic Duct Drainage as a salvage option to avoid major surgery.
Symptoms
- Severe upper abdominal pain — constant epigastric pain radiating to the back, worsening after meals
- Recurrent acute exacerbations — multiple hospital admissions over the past 12 months
- Significant weight loss — 8 kg over 6 months due to fear of eating
- Reduced quality of life — unable to work or sleep through the night
- Long-term opioid dependence — prescribed for ongoing pain control
Diagnostic Method
- MRCP — confirmed dilated pancreatic duct with multiple strictures and intraductal calculi
- CT abdomen — confirmed chronic pancreatitis with parenchymal calcification and ductal dilatation
- Review of prior ERCP reports — two failed cannulation attempts due to anatomical distortion and stricture
- Endoscopic Ultrasound (EUS) — high-resolution imaging confirming dilated main pancreatic duct accessible from the gastric wall
- Pre-procedure evaluation — fitness for advanced endoscopic intervention assessed and confirmed
Disease Diagnosed
Mr. Joshi was diagnosed with chronic pancreatitis with an obstructed and inaccessible main pancreatic duct. Conventional ERCP had failed twice due to severe ductal anatomy distortion. Without effective drainage, his pancreatic duct pressure remained high, perpetuating chronic pain and recurrent attacks. As a gastroenterology specialist for complex pancreatic disease, Dr. Rathod identified EUS-Guided Pancreatic Duct Drainage (EUS-PDD) as the safest and most effective alternative to open surgical drainage.
Risks if Left Untreated:
- Ongoing chronic pain and continued opioid dependence
- Repeated acute pancreatitis attacks and hospital admissions
- Progressive pancreatic insufficiency and diabetes
- Need for major open pancreatic surgery with extended recovery
Treatment Plan
Dr. Vipulroy Rathod performed EUS-Guided Pancreatic Duct Drainage as a salvage procedure after failed ERCP, creating a direct drainage channel between the stomach and pancreatic duct under real-time EUS guidance.
Why EUS-PDD Was Chosen Over Surgery
01 – Salvage After Failed ERCP Offers a definitive endoscopic solution when conventional ERCP cannot access the pancreatic duct due to anatomy or stricture.
02 – No Surgical Incision Drainage achieved entirely through the endoscope. No abdominal opening, no surgical wound, no extended hospital stay.
03 – Direct Pain Resolution Decompresses the obstructed pancreatic duct, addressing the root cause of chronic pancreatitis pain rather than treating symptoms alone.
04 – Faster Recovery Days of recovery instead of weeks. Most patients return to normal activity within a week, compared to 4 to 6 weeks after open surgical drainage.
How the Procedure Was Performed
- Linear Array EUS — echoendoscope passed through the mouth to the stomach, providing high-resolution imaging of the dilated pancreatic duct from the posterior gastric wall.
- Pancreatic duct puncture — 19G EUS needle advanced under real-time ultrasound guidance to puncture the dilated main pancreatic duct transgastrically.
- Pancreatogram — contrast injected to confirm needle position and map ductal anatomy, strictures, and calculi.
- Guidewire placement — guidewire negotiated across the stricture into the main pancreatic duct.
- Tract dilatation — gradual dilatation of the puncture tract using cystotome and balloon dilator.
- Stent deployment — a 7Fr plastic transmural stent placed between the stomach and pancreatic duct, establishing continuous internal drainage.
Procedure Summary
- Procedure: EUS-Guided Pancreaticogastrostomy (EUS-PDD)
- Stent: 7Fr plastic transmural stent
- Duration: 75 minutes
- Sedation: Conscious sedation with anaesthesia support
- Hospital Stay: Overnight, discharged the following morning
“When ERCP fails twice, patients are usually told the only option left is surgery. EUS-Guided Pancreatic Duct Drainage changes that conversation entirely. We accessed Mr. Joshi’s pancreatic duct directly through the stomach wall, decompressed it in a single session, and gave him real pain relief without a single incision. For complex chronic pancreatitis, this is the difference between a major surgery and going home the next morning.” Dr. Vipulroy Rathod, FASGE | Gastroenterologist in Mumbai | Director, Gastroenterology and Hepatobiliary Sciences, Fortis Hospital Mulund
Post-Procedure Guidelines
- Liquid and soft diet for 48 hours, advancing gradually as tolerated
- Avoid alcohol and high-fat foods strictly during the recovery and stent period
- Pain medication tapered under supervision as ductal decompression takes effect
- Stent review at 3 months with imaging to assess ductal healing and plan exchange or removal
- Follow-up with Dr. Vipulroy Rathod for symptom review and ongoing chronic pancreatitis management
Outcome
| Timepoint | Result |
|---|---|
| Within 24 hrs | Significant pain reduction reported, first comfortable night in months |
| Day 1 | Discharged from hospital, no wound care or surgical aftercare required |
| 1 Week | Returned to normal activity, opioid dependence reduced significantly |
| 1 Month | Sustained pain relief, weight stable, eating normally |
| 3 Months | Imaging confirmed reduced ductal dilatation, stent functioning well |
| 6 Months | Pain-free, off opioids, returned to full-time work |
Long-Term Expectations
With successful pancreatic duct decompression, Mr. Joshi’s chronic pancreatitis pain has resolved and his quality of life has been restored. The transmural stent will be reviewed and exchanged or removed based on imaging at scheduled follow-ups. Strict alcohol abstinence, dietary modification, and ongoing surveillance for pancreatic insufficiency or diabetes will remain central to his long-term care.
Patient Feedback
“For five years I lived with pain that controlled my entire life. Two ERCPs at other hospitals had failed and I was told surgery was my only option. Dr. Rathod gave me a different answer. The very next morning after his procedure I felt relief I had not felt in years. Today I am back at work, off painkillers, and finally living again. There are no words for what he has given my family.” Suresh Joshi, 47 | Pune, Maharashtra
“My husband had been suffering for years. We had stopped hoping. Dr. Rathod’s calm explanation, his honesty about the procedure, and the result speak for themselves. He is a blessing for chronic pancreatitis patients.” Mrs. Anita Joshi, Patient’s Wife | Pune, Maharashtra