Three-dimensional ERCP with cone-beam computed tomography: Novel approach to managing complex biliary strictures

Area of Science:

• Gastroenterology and Hepatology
• Medical Imaging
• Interventional Endoscopy

Background:

• Complex biliary strictures pose significant challenges in ERCP due to limited spatial visualization with traditional 2D fluoroscopy.
• Previous attempts at selective cannulation often fail in these complex cases.

Purpose of the Study:

• To evaluate the feasibility and clinical utility of novel three-dimensional (3D) fluoroscopic imaging using cone beam computed tomography (CBCT) during ERCP for managing complex biliary strictures.
• To assess the technical success rate (selective cannulation) and clinical success rate (successful stenting) of ERCP with CBCT.

Main Methods:

• A prospective cohort study included twenty consecutive patients with complex biliary strictures who had previously failed selective cannulation.
• ERCP was performed using a specialized fluoroscopic system enabling 360-degree rotational imaging with CBCT.
• Primary outcomes were technical success (selective cannulation) and clinical success (stenting without percutaneous drainage).

Main Results:

• CBCT achieved a 100% selective cannulation rate in all patients.
• Clinical success, defined as successful stenting without percutaneous drainage, was achieved in 90% of cases.
• The 3D reconstruction from CBCT influenced surgical planning in 10% of cases, with additional radiation exposure compared to standard ERCP.

Conclusions:

• ERCP with CBCT is technically feasible and demonstrates high selective cannulation rates for complex biliary strictures.
• The technique may offer significant value in cases with difficult selective cannulation and for surgical mapping in malignancies.
• Further research is warranted to determine optimal patient selection criteria and evaluate long-term outcomes.