Therapeutic Endoscopic Retrograde Cholangiopancreatography without Fluoroscopy in Four Critically Ill Patients Using Wire-Guided Intraductal Ultrasound

Abstract

Emergent endoscopic retrograde cholangiopancreatography cannot be performed at the bedside in critically ill patients in an intensive care unit because of the requirement for fluoroscopy. Moving such patients to a safe location where fluoroscopy is available can pose practical problems, and can lead to delayed intervention, which may adversely affect the outcome. We report the use of intraductal ultrasound to facilitate therapeutic biliary interventions in four critically ill patients in an intensive care unit. Cannulation was performed endoscopically at the bedside using a sphincterotome and a guide wire. Intraductal ultrasound, rather than fluoroscopy, was then used to confirm the location of the wire within the common bile duct prior to performing endoscopic sphincterotomy or stent placement. This technique was successful in all four patients.

References

• 1 Lin X Z, Chang K K, Shin J S. et al . Endoscopic nasobiliary drainage for acute suppurative cholangitis: a sonographically guided method.  Gastrointest Endosc. 1993;  39 174-176
• 2 Siegel J H, Rodriquez R, Cohen S A. et al . Endoscopic management of cholangitis: critical review of an alternative technique and report of a large series.  Am J Gastroenterol. 1994;  89 1142-1146
• 3 Schorn T F, Jahns U, Vollmer C, Gugler R. Ultrasound-guided emergency endoscopic retrograde biliary drainage without radiography.  Endoscopy. 1997;  29 232-233
• 4 Wang H P, Huang S P, Sun M S. et al . Urgent endoscopic nasobiliary drainage without fluoroscopic guidance: a useful treatment for critically ill patients with biliary obstruction.  Gastrointest Endosc. 2000;  52 741-744
• 5 Parada A A, Goncalves M O, Tafner E. et al . Endoscopic papillotomy under ultrasonographic control.  Int Surg. 1991;  76 75-76
• 6 Zagoni T, Tulassay Z. Endoscopic sphincterotomy without fluoroscopic control in pregnancy.  Am J Gastroenterol. 1995;  90 1028
• 7 Llach J, Bordas J M, Gines A. et al . Endoscopic sphincterotomy in pregnancy.  Endoscopy. 1997;  29 52-53
• 8 Berger Z. Endoscopic papillotomy without fluoroscopy in pregnancy.  Endoscopy. 1998;  30 313
• 9 Misra S P, Dwivedi M. A new time-saving technique of inserting multiple biliary endoprostheses without fluoroscopy.  Endoscopy. 1997;  29 58
• 10 Misra S P, Dwivedi M. Endoscopic sphincterotomy without image intensification.  Endoscopy. 1997;  29 886-887
• 11 Misra S P, Dwivedi M. Should therapeutic ERCP be conducted in special circumstances without fluoroscopy? Pro.  Endoscopy. 1998;  30 306-307
• 12 Venu R P, Brown R D. Should ERCP be conducted in special circumstances without fluoroscopy? Contra.  Endoscopy. 1998;  30 308-310
• 13 Fusaroli P, Caletti G. Endoscopic ultrasonography.  Endoscopy. 2003;  35 127-135
• 14 Costamagna G, Tringali A, Shah S K. et al . Long-term follow-up of patients after endoscopic sphincterotomy for choledocholithiasis, and risk factors for recurrence.  Endoscopy. 2002;  34 273-279
• 15 Fogel E L, Sherman S, Park S H. et al . Therapeutic biliary endoscopy.  Endoscopy. 2003;  35 156-163
• 16 Menzel J, Domschke W. Intraductal ultrasonography (IDUS) of the pancreato-biliary duct system: personal experience and review of literature.  Eur J Ultrasound. 1999;  10 105-115
• 17 Tamada K, Nagai H, Yasuda Y. et al . Transpapillary intraductal ultrasound prior to biliary drainage in the assessment of longitudinal spread of extrahepatic bile duct carcinoma.  Gastrointest Endosc. 2001;  53 300-307
• 18 Chak A, Isenberg G, Kobayashi K. et al . Prospective evaluation of an over-the-wire catheter US probe.  Gastrointest Endosc. 2000;  51 202-205
• 19 Levy M J, Vazquez-Sequeiros E, Wiersema M J. Evaluation of the pancreaticobiliary ductal systems by intraductal US.  Gastrointest Endosc. 2002;  55 397-408
• 20 Das A, Isenberg G, Wong R C. et al . Wire-guided intraductal US: an adjunct to ERCP in the management of bile duct stones.  Gastrointest Endosc. 2001;  54 31-36
• 21 Tseng L J, Jao Y T, Mo L R, Lin R C. Over-the-wire US catheter probe as an adjunct to ERCP in the detection of choledocholithiasis.  Gastrointest Endosc. 2001;  54 720-723
• 22 Vazquez-Sequeiros E, Baron T H, Clain J E. et al . Evaluation of indeterminate bile duct strictures by intraductal US.  Gastrointest Endosc. 2002;  56 372-379
• 23 Farrell R J, Agarwal B, Brandwein S L. et al . Intraductal US is a useful adjunct to ERCP for distinguishing malignant from benign biliary strictures.  Gastrointest Endosc. 2002;  56 681-687