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

doi:10.1016/j.gie.2009.10.048

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 journal › Article › peer-review

93 Scopus citations

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 language	English
Pages (from-to)	1166-1173
Number of pages	8
Journal	Gastrointestinal Endoscopy
Volume	71
Issue number	7
DOIs	https://doi.org/10.1016/j.gie.2009.10.048
State	Published - 1 Jan 2010
Externally published	Yes

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Gastroenterology

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10.1016/j.gie.2009.10.048

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title = "Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP",

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.",

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

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doi = "10.1016/j.gie.2009.10.048",

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T1 - Therapeutic EUS-assisted endoscopic retrograde pancreatography after failed pancreatic duct cannulation at ERCP

AU - Barkay, Olga

AU - Sherman, Stuart

AU - McHenry, Lee

AU - Yoo, Byung Moo

AU - Fogel, Evan L.

AU - Watkins, James L.

AU - DeWitt, John

AU - Al-Haddad, Mohammad A.

AU - Lehman, Glen A.

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N2 - 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.

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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SN - 0016-5107

VL - 71

SP - 1166

EP - 1173

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 7

ER -

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

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