言語種別	英語
発表タイトル	Endoscopic troubleshooting for pancreatic　diseases in surgically altered anatomy
会議名	第65回日本膵臓学会大会
学会区分	全国規模の学会
発表形式	口頭
講演区分	シンポジウム・ワークショップ パネル（公募）
発表者・共同発表者	◎豊永啓翔，正木誠人，高山拓也，中川達矢，折野匡洋，松本浩尚，住本貴美，潟沼朗生，島谷昌明
発表年月日	2025/07/25
開催地 （都市, 国名）	ホテルニューオータニ　東京　（東京千代田区）
開催期間	2025/07/25～2025/07/26
学会抄録	ウェブ
概要	Introduction：In patients with surgically altered anatomy（SAA）, pancreatic diseases are treated with balloon enteroscopy（BE）-assisted ERCP or endoscopic ultrasound（I-EUS）, but these procedures involve technical challenges. BE-ERCP：BE-ERCP is challenging due to difficulty in target access, reduced maneuverability, and limited devices. Scope insertion should align with reconstruction type, employing over-tube adjustments, abdominal compression, and scope manipulation techniques for severe adhesions. Gel immersion and image-enhanced endoscopy aid pancreatic duct（PD）orifice identification. Optimizing scope configuration and papilla orientation improves cannulation. Novel devices and techniques enable effective PD cannulation, pancreatojejunostomy stenosis（ PJS）dilation, and management of proximally migrated stents, among other interventions. I-EUS： EUS-guided pancreatic drainage is a viable alternative when BE-ERCP is unfeasible in SAA but remains technically challenging due to narrow ducts, stenosis, and stent management. Low Echo Reduction mode enhances PD visualization, improving puncture accuracy. A two-step puncture facilitates PD access；contrast injection for PD expansion followed by optimized repuncture. For completely obstructed PJS, a guidewire stiff-tip puncture serves as a rescue approach for recanalization. As EUS-PD often requires re-intervention, appropriate and effective stent removal techniques have been developed. Conclusion： Troubleshooting strategies for pancreatic diseases in SAA enhance success and reduce complications, warranting further validation.