Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP

Olga Barkay, Stuart Sherman, Lee McHenry, Byung Moo Yoo, Evan L. Fogel, James L. Watkins, John DeWitt, Mohammad A. Al-Haddad, Glen A. Lehman

Research output: Contribution to journalArticle

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Abstract

Background: Cannulation of the pancreatic duct (PD) during endoscopic retrograde pancreatography (ERP) can fail even in experienced hands. A technique for therapeutic EUS-assisted rendezvous ERP has been described in a few case reports. Objective: To investigate the efficacy and safety of therapeutic EUS-assisted ERP. Design: Retrospective study. Setting: Tertiary-care medical center. Patients: This study involved 21 patients after failed ERP. Intervention: EUS-guided transgastric pancreatography by using a mixture of contrast media and methylene blue was attempted. If that was successful, ERP was attempted by using methylene blue flow as an indicator of the PD orifice or by a rendezvous technique using a wire passed into the PD and the small bowel through the EUS needle. Main Outcome Measurements: Technical success rate and complications. Results: The PD was of a normal diameter in 7 patients and was dilated in 14 patients. EUS-guided pancreatography was successfully done in all patients with a dilated PD but only in 4 of 7 patients (57%) with normal-diameter PDs. In 6 patients, ERP was successfully performed by using methylene blue flow as an indicator of the PD orifice. The rendezvous technique was successful in 4 of 12 cases (33%), and reasons for failure were either a tight stricture (n = 5) or a suboptimal angle of EUS needle insertion (n = 3). Overall, EUS-assisted ERP was successful in 10 of 21 patients (48%). Complications included peripancreatic abscess in 1 patient and mild pancreatitis in 1 patient. Limitations: Retrospective study, small sample size. Conclusion: EUS-assisted ERP is a complex procedure that can provide access to the PD in selected cases after failed standard ERP.

Original languageEnglish (US)
Pages (from-to)1166-1173
Number of pages8
JournalGastrointestinal endoscopy
Volume71
Issue number7
DOIs
StatePublished - Jun 2010

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Endoscopic Retrograde Cholangiopancreatography
Pancreatic Ducts
Catheterization
Methylene Blue
Therapeutics
Needles
Retrospective Studies
Tertiary Care Centers
Pancreatitis
Sample Size
Abscess
Contrast Media
Pathologic Constriction
Safety

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP. / Barkay, Olga; Sherman, Stuart; McHenry, Lee; Yoo, Byung Moo; Fogel, Evan L.; Watkins, James L.; DeWitt, John; Al-Haddad, Mohammad A.; Lehman, Glen A.

In: Gastrointestinal endoscopy, Vol. 71, No. 7, 06.2010, p. 1166-1173.

Research output: Contribution to journalArticle

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AB - Background: Cannulation of the pancreatic duct (PD) during endoscopic retrograde pancreatography (ERP) can fail even in experienced hands. A technique for therapeutic EUS-assisted rendezvous ERP has been described in a few case reports. Objective: To investigate the efficacy and safety of therapeutic EUS-assisted ERP. Design: Retrospective study. Setting: Tertiary-care medical center. Patients: This study involved 21 patients after failed ERP. Intervention: EUS-guided transgastric pancreatography by using a mixture of contrast media and methylene blue was attempted. If that was successful, ERP was attempted by using methylene blue flow as an indicator of the PD orifice or by a rendezvous technique using a wire passed into the PD and the small bowel through the EUS needle. Main Outcome Measurements: Technical success rate and complications. Results: The PD was of a normal diameter in 7 patients and was dilated in 14 patients. EUS-guided pancreatography was successfully done in all patients with a dilated PD but only in 4 of 7 patients (57%) with normal-diameter PDs. In 6 patients, ERP was successfully performed by using methylene blue flow as an indicator of the PD orifice. The rendezvous technique was successful in 4 of 12 cases (33%), and reasons for failure were either a tight stricture (n = 5) or a suboptimal angle of EUS needle insertion (n = 3). Overall, EUS-assisted ERP was successful in 10 of 21 patients (48%). Complications included peripancreatic abscess in 1 patient and mild pancreatitis in 1 patient. Limitations: Retrospective study, small sample size. Conclusion: EUS-assisted ERP is a complex procedure that can provide access to the PD in selected cases after failed standard ERP.

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