Endoscopic ultrasound-guided biliary access versus precut papillotomy in patients with failed biliary cannulation: a retrospective study

Alexander Lee; Anupam Aditi; Yasser M. Bhat; Kenneth F. Binmoeller; Chris Hamerski; Oriol Sendino; Steve Kane; John P. Cello; Lukejohn W. Day; Medi  Mohamadnejad; V. Raman Muthusamy; Rabindra Watson; Jason B. Klapman; Sri Komanduri; Sachin Wani; Janak N. Shah

doi:10.1055/s-0042-120995

Endoscopy, Inhaltsverzeichnis

Endoscopy 2017; 49(02): 146-153
DOI: 10.1055/s-0042-120995

Original article

Endoscopic ultrasound-guided biliary access versus precut papillotomy in patients with failed biliary cannulation: a retrospective study

Alexander Lee

¹Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA

,

Anupam Aditi

¹Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA

,

Yasser M. Bhat

²Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA

,

Kenneth F. Binmoeller

²Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA

,

Chris Hamerski

²Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA

,

Oriol Sendino

²Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA

,

Steve Kane

²Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA

,

John P. Cello

¹Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA

,

Lukejohn W. Day

¹Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA

,

Medi Mohamadnejad

³Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA

,

V. Raman Muthusamy

³Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA

,

Rabindra Watson

³Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA

,

Jason B. Klapman

⁴Department of Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA

,

Sri Komanduri

⁵Department of Gastroenterology, Northwestern University, Chicago, Illinois, USA

,

Sachin Wani

⁶Department of Gastroenterology, University of Colorado, Denver, Colorado, USA

,

Janak N. Shah

²Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA

› Institutsangaben

Abstract

Background and aims Precut papillotomy is widely used after failed biliary cannulation. Endoscopic ultrasound (EUS)-guided biliary access techniques are newer methods to facilitate access and therapy in failed cannulation. We evaluated the impact of EUS-guided biliary access on endoscopic retrograde cholangiopancreatography (ERCP) success and compared these techniques to precut papillotomy.

Patients and methods We retrospectively compared two ERCP cohorts. One cohort consisted of biliary ERCPs (n = 1053) attempted in patients with native papillae and surgically unaltered anatomy in whom precut papillotomy and/or EUS-guided biliary access were routinely performed immediately after failed cannulation. This cohort was compared with a similar ERCP cohort (n = 1062) in which only precut papillotomy was available for failed cannulation. The following outcomes were compared: conventional cannulation success, rates of attempted advanced access techniques (precut or EUS), precut success, EUS-guided biliary access success, and ERCP failure rates.

Results Although conventional cannulation success, rates of attempted advanced access technique (precut or EUS), and precut success were similar, the ERCP failure rate was lower when both EUS-guided biliary access and precut were available (1.0 % [95 % confidence interval (CI) 0.4 – 1.6]), compared with when only precut was possible for failed access (3.6 % [95 %CI 2.5 – 4.7]; P < 0.001). Success for EUS-guided biliary access (95.1 % [95 %CI 89.7 – 100]) was significantly higher than for precut (75.3 % [95 %CI 68.2 – 82.4]; P < 0.001), and mainly due to superiority in malignant obstruction (93.5 % vs. 64 %; P < 0.001).

Conclusions EUS-guided biliary access decreases the rate of therapeutic biliary ERCP failure. Our results support the use of EUS-guided biliary access to optimize single-session ERCP success. In experienced hands, these techniques appear as effective, if not more so, than precut papillotomy.

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Referenzen

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