Usefulness of an injection needle in treating complete obstruction of the pancreaticojejunal anastomosis

Background and Aims: Stenosis at pancreaticojejunal (PJ) anastomosis is a recognized adverse event after pancreaticoduodenectomy. Although double-balloon endoscopic retrograde cholangiopancreatography (DB-ERCP) can be used for management, this procedure is often technically challenging. Methods: We describe a case in which complete obstruction of PJ anastomosis was successfully treated by identifying the anastomosis with contrast injection through a standard injection needle. Results: Pancreatography was performed by puncturing the area suspected to be the anastomosis with a 25-gauge injection needle. After pancreatography, the anastomosis was dilated using a balloon catheter, and endoscopic nasopancreatic duct drainage was placed. No adverse events occurred. Conclusions: After DB-ERCP, pancreatic duct dilatation improved. Pancreatography and treatment of PJ anastomotic obstruction can be performed safely by puncturing the anastomotic site with an injection needle.