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Endosonography-guided cholangiopancreatography
M J Wiersema1, D Sandusky, R Carr
1Department of Medicine, St. Vincent Hospitals and Health Services, Indianapolis, Indiana, USA.
Gastrointestinal Endoscopy
|February 1, 1996
Summary
Endoscopic ultrasound-guided cholangiopancreatography (EGCP) offers a successful alternative for duct imaging when endoscopic retrograde cholangiopancreatography (ERCP) fails. This novel technique achieved a 73% success rate in challenging cases.
Area of Science:
- Gastroenterology
- Medical Imaging
- Interventional Endoscopy
Background:
- Endoscopic ultrasound (EUS) enables detailed imaging of the common bile duct and pancreatic duct.
- A novel technique, endosonography-guided cholangiopancreatography (EGCP), has been developed using a custom flexible needle.
Purpose of the Study:
- To evaluate the efficacy and safety of EGCP as an alternative to ERCP for ductography.
- To assess EGCP's success rate in patients where ERCP was unsuccessful.
Main Methods:
- EGCP was attempted in 11 patients with failed ERCP using a linear array echoendoscope and a 22-23 gauge aspiration needle.
- Procedures included transduodenal cholangiography (10 patients) and transgastric pancreatography (1 patient).
Main Results:
- Successful ductography was achieved in 8 of 11 patients (73% success rate for EGCP vs. 0% for ERCP, p < .001).
- EGCP findings led to repeat ERCP with precut sphincterotomy in 5 patients, showing 100% agreement.
- One case of postprocedure pancreatitis occurred when EGCP was performed during the same session as failed ERCP; no complications arose when performed separately.
Conclusions:
- EGCP provides a viable alternative for cholangiopancreatography when ERCP is unsuccessful.
- Further research is needed to fully establish the safety and success rates of EGCP.