Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video) - 23/08/11
Reprint requests: Raj J. Shah, MD, Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Health Science Center, 1635 N Ursula St, PO Box 6510, MS F735, AIP 2.031, Aurora, CO 80045.Aurora, Colorado, USA
Abstract |
Background |
When conventional ERCP methods fail because of periampullary or ductal obstruction, EUS-guided cholangiopancreatography (EUS-CP) may aid in pancreaticobiliary access.
Objective |
To report our experience when using single-operator EUS-CP.
Setting |
An academic tertiary-referral center.
Methods |
Consecutive patients undergoing EUS-CP were prospectively identified. These patients had undergone failed attempt(s) at therapeutic ERCP. A data sheet was used to record indications, reasons for failed ERCP, EUS-CP visualization of the duct of interest, transpapillary or transenteric intervention, clinical follow-up, and complications.
Main Outcome Measurements |
Technical success was decompression of the duct of interest. Clinical success was resolution of jaundice or a ≥50% reduction in pain or narcotics, as applicable.
Results |
Between February 2003 and June 2007, EUS-CP was attempted in 20 patients (11 men, 9 women; mean [SD] age 58 ± 14.9 years). Indications included jaundice (n = 8), biliary stones (n = 3), chronic pancreatitis (n = 6), acute pancreatitis (n = 2), and papillary stenosis (n = 1). Reasons for failed ERCP included periampullary mass (n = 8), intradiverticular papillae (n = 4), and pancreatic duct (PD) stricture (n = 7) or stone (n = 1). Technical success was achieved in 18 of 20 patients (90%). Biliary decompression was obtained in 11 of 12 patients (92%) (7 transpapillary and 4 transenteric-transcholedochal). Pancreatic decompression was obtained in 7 of 8 patients (88%) (3 transpapillary, 4 transgastric). On follow-up, clinical improvement was noted in 15 of 20 patients (70%). For treatment of pain associated with chronic pancreatitis, pain scores decreased by a mean of 1.75 (P = .18). Complications (in 2 of 20 [10%]) included perforation (n = 1) and respiratory failure (n = 1).
Limitations |
A single-center nonrandomized observational study with a small patient population.
Conclusions |
At our academic referral center, single-operator EUS-CP provided decompression of obstructed ducts and may be performed after a failed attempt at conventional ERCP during the same endoscopic session.
Le texte complet de cet article est disponible en PDF.Abbreviations : EHL, EUS-CP, PD, PTC
Plan
| DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: Y. K. Chen: Research and educational grants from Olympus America; R. J. Shah: speaking honoraria from Cook Endoscopy and Boston Scientific. All other authors disclosed no financial relationships relevant to this publication. |
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| Presented at Digestive Disease Week, May 20-23, 2007, Washington, DC (Gastrointest Endosc 2007;65:AB209). |
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| If you would like to chat with an author of this article, you may contact him at Raj.Shah@uchsc.edu. |
Vol 70 - N° 3
P. 471-479 - septembre 2009 Retour au numéro
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