To assess the effectiveness and safety of EUS-guided endoscopic anastomosis between the main pancreatic duct and the stomach (pancreaticogastrostomy) in patients in whom transpapillary access to the main pancreatic duct could not be achieved during ERCP.

A retrospective analysis of treatment outcomes of all pancreatitis patients who underwent EUS-guided pancreaticogastrostomy between 2018 and 2025 at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University in Toruń.

EUS-guided pancreaticogastrostomy was performed in 13 patients with chrinic pancreatitis (11 men, 2 women; mean age 49.26 [36–66] years) due to lack of transpapillary access during ERCP. Main pancreatic duct strictures in the pancreatic head due to chronic pancreatitis were diagnosed in 7/13 (53.85%) patients. Disconnected pancreatic duct syndrome was identified in 4/13 (30.77%) patients. Postprocedural stricture of pancreaticogastrostomy anasotmosis were diagnosed in 2/13 (15.38%) patients. Technical success was achieved in 12/13 (92.31%) patients. Complications occurred in 3/13 (23.08%) patients. Clinical success was achieved in 12/13 (92.31%) patients. Mean follow-up was 1055 (148–1732) days. Long-term success was achieved in 11/13 (84.61%) patients.

EUS-guided endoscopic pancreaticogastrostomy seems an effective and safe treatment method when transpapillary access to the main pancreatic duct is not possible.