Endoscopy 2019; 51(04): S184
DOI: 10.1055/s-0039-1681716
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:30 – 14:00: ERCP cannulation 1 ePoster Podium 3
Georg Thieme Verlag KG Stuttgart · New York

DIFFICULT BILIARY CANNULATION IN PATIENTS WITH DISTAL MALIGNANT BILIARY OBSTRUCTION: AN UNDERESTIMATED PROBLEM?

A Anderloni
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
F D'Amico
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
A Fugazza
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
E Troncone
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
G Donato
2   Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
,
P Occhipinti
2   Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
,
A Amato
3   Valduce Hospital, Como, Italy
,
F Radaelli
3   Valduce Hospital, Como, Italy
,
G Mogavero
3   Valduce Hospital, Como, Italy
,
I Tarantino
4   IRCCS-ISMETT, Palermo, Italy
,
M Amata
4   IRCCS-ISMETT, Palermo, Italy
,
D Ligresti
4   IRCCS-ISMETT, Palermo, Italy
,
M Spadaccini
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
V Craviotto
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
L Lamonaca
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
,
PJ Belletrutti
5   University of Calgary, Calgary, Canada
,
A Repici
1   Humanitas Clinical and Research Center, Rozzano (MI), Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    To date, there are no available data on rates of difficult biliary cannulation (DBC) in the specific setting of patients (pts) with distal biliary malignant obstruction (DBMO). Aim of the study was to investigate the incidence and outcome of DBC in patients undergoing ERCP for DBMO.

    Tab. 1:

    Total adverse events in patients with distal malignant biliary obstruction

    Adverse events

    non DBC Group 27/245 (11,2%)

    DBC Group 55/277 (19,8%)

    p value = 0,005632

    PEP/Bleeding

    9 (3,7%)/2 (1%)

    15 (5,4%)/14 (5%)

    Cholangitis/Stent migration

    8 (3,3%)/2 (1%)

    10 (3,6%)/5 (1,8%)

    Others

    6 (2,4%)

    11 (3.9%)

    Methods:

    Retrospective multicentric analysis of all consecutive pts with DBMO that underwent ERCP from 09/2014 to 10/2017. The primary outcome was to evaluate the rate of DBC (according to ESGE guidelines), secondary outcome was the rate of adverse events (AEs)(according to ASGE lexicon).

    Results:

    A total of 522 pts (48.6% female; mean age 73.05) were included. DBC occurred in 277 pts (53%). The technique performed were: fistulotomy in 191 pts (69%), double guidewire technique in 10 (3,6%), transpancreatic sphincterotomy in 25 (9%); more than one of these techniques combined in 15 pts (5,4%); deep biliary cannulation after several attempts with sphincterotome and guide wire in 15 pts (5,4%). Failure of biliary cannulation occurred in 53 pts (10,1%) requiring: EUS-guided biliary drainage in 36 pts (67,9%), EUS guided rendez-vous with transpapillary stent placement in 2 (3,8%), percutaneous transhepatic biliary drainage in 8 (15,1%), second successfull ERCP after pre-cut in 6 (11,3%), surgical bypass in 1 (1,9%).

    Overall AEs rate was 15,7%(82/522 pts): 19,8%(55/277) in DBC Group vs. 11,02%(27/245) in non DBC group (p value = 0,005632).

    Conclusions:

    Patients with DBMO have a high rate of DBC (53%) requiring alternative techniques for biliary drainage. This translates to higher rates of AEs in patients with DBC. Further prospective multicentric studies are needed to confirm these data and to evaluate the best approach for biliary drainage in this specific subgroup of patients.


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