Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video)

Brian C. Brauer, Yang K. Chen, Norio Fukami, Raj J. Shah

Research output: Contribution to journalArticle

89 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)471-479
Number of pages9
JournalGastrointestinal Endoscopy
Volume70
Issue number3
DOIs
StatePublished - Sep 1 2009
Externally publishedYes

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Endoscopic Retrograde Cholangiopancreatography
Decompression
Chronic Pancreatitis
Jaundice
Pathologic Constriction
Pain
Pancreatic Ducts
Narcotics
Tertiary Care Centers
Chronic Pain
Respiratory Insufficiency
Pancreatitis
Observational Studies
Referral and Consultation
Therapeutics
Population

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video). / Brauer, Brian C.; Chen, Yang K.; Fukami, Norio; Shah, Raj J.

In: Gastrointestinal Endoscopy, Vol. 70, No. 3, 01.09.2009, p. 471-479.

Research output: Contribution to journalArticle

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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.",
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N2 - 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.

AB - 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.

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