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Endoscopy 2017; 49(02): 146-153
DOI: 10.1055/s-0042-120995
Original article
© Georg Thieme Verlag KG Stuttgart · New York

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

Alexander Lee
1   Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
,
Anupam Aditi
1   Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
,
Yasser M. Bhat
2   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
Kenneth F. Binmoeller
2   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
Chris Hamerski
2   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
Oriol Sendino
2   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
Steve Kane
2   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
,
John P. Cello
1   Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
,
Lukejohn W. Day
1   Department of Gastroenterology, San Francisco General Hospital, San Francisco, California, USA
,
Medi Mohamadnejad
3   Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA
,
V. Raman Muthusamy
3   Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA
,
Rabindra Watson
3   Department of Gastroenterology, University of California-Los Angeles, Los Angeles, California, USA
,
Jason B. Klapman
4   Department of Gastroenterology, Moffitt Cancer Center, Tampa, Florida, USA
,
Sri Komanduri
5   Department of Gastroenterology, Northwestern University, Chicago, Illinois, USA
,
Sachin Wani
6   Department of Gastroenterology, University of Colorado, Denver, Colorado, USA
,
Janak N. Shah
2   Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA
› Author Affiliations
Further Information

Publication History

submitted 28 February 2016

accepted after revision 06 October 2016

Publication Date:
20 January 2017 (online)

Also available at
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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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