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Antegrade brushing cytology through the EUS-guided pancreatic duct drainage route (with video)

 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan

Date of Submission09-Dec-2020
Date of Acceptance23-Mar-2021
Date of Web Publication26-Jun-2021

Correspondence Address:
Takeshi Ogura,
2nd Department of Internal Medicine, Osaka Medical College, 2-7 Daigakuchou, Takatsukishi, Osaka 569-8686
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EUS-D-20-00258

PMID: 34213432

How to cite this URL:
Ogura T, Ueno S, Okuda A, Nishioka N, Higuchi K. Antegrade brushing cytology through the EUS-guided pancreatic duct drainage route (with video). Endosc Ultrasound [Epub ahead of print] [cited 2021 Nov 27]. Available from: http://www.eusjournal.com/preprintarticle.asp?id=319476

In general, pancreatic duct (PD) stenosis is histologically diagnosed by brushing cytology under ERCP. However, its diagnostic accuracy is limited.[1],[2] In addition, if PD access is not possible due to PD obstruction caused by a large PD stone, this technique cannot be attempted. Recently, the infinity cytology device (7.5Fr, US Endoscopy, Mentor, OH), which is a wire-guided cytology brush that is thinner than conventional infinity cytology devices (9.0Fr),[3],[4],[5] has become available in Japan [Figure 1]. We herein describe successful antegrade brushing cytology for PD stenosis through the EUS-guided PD route.
Figure 1: Infinity cytology device (7.5Fr, US Endoscopy, Mentor, OH) for wire-guided cytology brushing

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A 49-year-old male was admitted to our hospital due to liver damage and acute pancreatitis. Computed tomography revealed the presence of large stones in the pancreatic head, and hence, ERCP was performed. However, although a biliary stent was successfully deployed, PD access was unsuccessful. Therefore, EUS-PD drainage using a plastic stent was performed [Figure 2]. After 3 months, a scheduled stent exchange was attempted. Following the removal of the plastic stent, an ERCP catheter was antegrade inserted into the PD. Subsequent injection of the contrast medium revealed pancreatic body stenosis [Figure 3]. To differentiate between benign and malignant pancreatic stenosis, the infinity brushing cytology device was inserted, and brushing cytology was performed without any adverse events []Figure 4] and Video 1] [Additional file 1]. Finally, plastic stent deployment was performed [Figure 5]. This patient was finally diagnosed with benign PD stricture.
Figure 2: EUS-guided pancreatic duct drainage using a plastic stent was successfully performed

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Figure 3: Pancreatic duct stenosis in the pancreatic body is seen (yellow arrow)

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Figure 4: Brushing cytology using the infinity cytology device was performed

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Figure 5: Successful EUS-guided pancreatic duct drainage using a plastic stent

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Although comparative studies between this novel device and conventional devices are needed, this novel brushing cytology device might be useful not only under ERCP guidance but also for the antegrade approach, because it is both thin and enables adequate cell sampling.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

Takeshi Ogura is an Editorial Board Member of Endoscopic Ultrasound. The article was subject to the journal's standard procedures, with peer review handled independently of this Member and his research groups. There are no other conflicts of interest.

  References Top

Pereira P, Morais R, Vilas-Boas F, et al. Brush cytology performance for the assessment of biliopancreatic strictures. Acta Cytol 2020;64:344-51.  Back to cited text no. 1
Al-Hajeili M, Alqassas M, Alomran A, et al. The diagnostic accuracy of cytology for the diagnosis of hepatobiliary and pancreatic cancers. Acta Cytol 2018;62:311-6.  Back to cited text no. 2
Kylänpää L, Boyd S, Ristimäki A, et al. A prospective randomised study of dense Infinity cytological brush versus regularly used brush in pancreaticobiliary malignancy. Scand J Gastroenterol 2016;51:590-3.  Back to cited text no. 3
Bank JS, Witt BL, Taylor LJ, et al. Diagnostic yield and accuracy of a new cytology brush design compared to standard brush cytology for evaluation of biliary strictures. Diagn Cytopathol 2018;46:234-8.  Back to cited text no. 4
Nakahara K, Michikawa Y, Morita R, et al. Diagnostic ability of endoscopic bile cytology using a newly designed biliary scraper for biliary strictures. Dig Dis Sci 2019;64:241-8.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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