Aims In cases of failed ERCP, the endosonography-guided cholangiopancreatography (ESCP)
has positioned as an effective alternative comparable to the percutaneous approach.
Furthermore, in several tertiary centers, the EUS and ERCP combination in a single
procedure, is a well-accepted routine strategy. Main aims were to report a cumulative
experience of ESCP from a referral center, with the purpose to assess:
-
the ESCP role over the total ERCPs cases;
-
general outcomes as technical, clinical success and safety.
Methods This is a single-center retrospective cohort analysis. Period: October2010 - October2019.
Technical success for Rendez-Vous (RV, papilla identification/cannulation); and transmural
drainage (successful stent placement). Clinical success for tumoral jaundice (> 50%
bilirubin decrease after 4 weeks); for choledocholithiasis (cannulation and stones
clearance); and chronic pancreatitis (significant pain improvement after 4 weeks).
Failed RV cases were crossed to transmural/anterograde with intention to treat.
Results A total of 233 combined procedures (EUS+/-ERCP) were performed of 6480 scheduled
ERCP procedures (3.6%). Detailed revision of 85 ESCP (1.3%) was done. EUS-guided pancreatography
(n=16) and cholangiography (n = 67) in 100% of cases. Technical and clinical success
rates were 90.5% and 80% respectively. EUS-guided RV (n=32) technically successful
in 30% and 72% of pancreatic and biliary procedures respectively. In 12 failed RV
were crossed to direct interventions. Transmural interventions (n=69) included pancreaticogastrostomy/duodenostomy
(n=11), choledochoduodenostomy (n=32), hepaticogastrostomy (n=9) and anterograde stent
(n = 2). Procedure related adverse events (21.2%) were more frequent (p< 0.05) and
severe (p< 0.05) in malignant biliary pathology. Late stent dysfunction in 3 cases.
Five procedure-related deaths related to procedures were detected.
Conclusions ESCP has a role reserved for a minority of selected cases with failed ERCP. It helps
to improve the global efficacy of endoscopy drainage, but is not an adverse event
free procedure, especially in malignant biliary pathology, and should be reserved
in referral centers.
