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

Olga Barkay, Stuart Sherman, Lee McHenry, Byung Moo Yoo, Evan Fogel, James L. Watkins, John DeWitt, Mohammad A. Al-Haddad, Glen 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
Pages (from-to)1166-1173
Number of pages8
JournalGastrointestinal Endoscopy
Volume71
Issue number7
DOIs
StatePublished - 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

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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

In: Gastrointestinal Endoscopy, Vol. 71, No. 7, 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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