کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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3307837 | 1210391 | 2009 | 9 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video) Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video)](/preview/png/3307837.png)
BackgroundWhen conventional ERCP methods fail because of periampullary or ductal obstruction, EUS-guided cholangiopancreatography (EUS-CP) may aid in pancreaticobiliary access.ObjectiveTo report our experience when using single-operator EUS-CP.SettingAn academic tertiary-referral center.MethodsConsecutive 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 MeasurementsTechnical success was decompression of the duct of interest. Clinical success was resolution of jaundice or a ≥50% reduction in pain or narcotics, as applicable.ResultsBetween 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).LimitationsA single-center nonrandomized observational study with a small patient population.ConclusionsAt 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.
Journal: Gastrointestinal Endoscopy - Volume 70, Issue 3, September 2009, Pages 471–479