Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos) - 15/01/12
Reprint requests: Vinay Dhir, MD, DNB, Institute of Advanced Endoscopy, 5th floor, Om Chambers, 123, August Kranti Marg, Mumbai, 400026, IndiaRésumé |
Background |
Precut papillotomy after failed bile duct cannulation is associated with an increased risk of pancreatitis. EUS-guided rendezvous drainage is a novel alternative technique, but there are no data comparing this approach with precut papillotomy.
Objective |
To evaluate the safety and efficacy of EUS-guided rendezvous drainage of the bile duct and compare its outcome with that of precut papillotomy.
Design |
Retrospective study.
Setting |
Tertiary care referral center.
Patients |
Consecutive patients with distal bile duct obstruction, in whom selective cannulation of the bile duct at ERCP failed after 5 attempts with a guidewire and sphincterotome, underwent an EUS-guided rendezvous procedure. The outcomes were compared with those in a historical cohort of patients who underwent precut papillotomy.
Interventions |
Patients in whom selective cannulation failed underwent EUS-guided rendezvous drainage by use of the short wire technique or precut papillotomy by use of the Erlangen papillotome. At EUS, after the extrahepatic bile duct was punctured with a 19-gauge needle, a hydrophilic angled-tip guidewire 260 cm long was passed in an antegrade manner across the papilla into the duodenum. The echoendoscope was then exchanged for a duodenoscope, which was introduced alongside the EUS-placed guidewire. The transpapillary guidewire was retrieved through its biopsy channel, and accessories were passed over the wire to perform the requisite endotherapy.
Main Outcome Measures |
Comparison of the rates of technical success and complications between patients treated by the EUS-guided rendezvous and those treated by precut papillotomy techniques. Treatment success was defined as completion of the requisite endotherapy in one treatment session.
Results |
Treatment success was significantly higher for the EUS-guided rendezvous (57/58 patients) than for those undergoing precut papillotomy technique (130/144 patients) (98.3% vs 90.3%; P = .03). There was no significant difference in the rate of procedural complications between the EUS and precut papillotomy techniques (3.4% vs 6.9%, P = .27).
Limitations |
Retrospective nonrandomized study design; highly selective patient cohort.
Conclusions |
In this study, the EUS-guided rendezvous technique was found to be superior to precut papillotomy for single-session biliary access. Prospective randomized trials are needed to confirm these preliminary but promising findings.
Le texte complet de cet article est disponible en PDF.Abbreviations : CBD, PTBD
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| See CME section; p. 399. |
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| If you would like to chat with an author of this article, you may contact Dr Dhir at vinaydhir@gmail.com. |
Vol 75 - N° 2
P. 354-359 - février 2012 Retour au numéro
Article précédent
- Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study
- Peter V. Draganov, Shailendra Chauhan, Mihir S. Wagh, Anand R. Gupte, Tong Lin, Wei Hou, Chris E. Forsmark
- EUS-guided biliary rendezvous: EUS to the rescue
- Won Jae Yoon, William R. Brugge
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