Elsevier

Gastrointestinal Endoscopy

Volume 76, Issue 6, December 2012, Pages 1133-1141
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey

https://doi.org/10.1016/j.gie.2012.08.001Get rights and content

Background

EUS-guided cholangiopancreatography (ESCP) allows transmural access to biliopancreatic ducts when ERCP fails. Data regarding technical details, safety, and outcomes of ESCP are still unknown.

Objective

To evaluate outcomes of ESCP in community and referral centers at the initial development phase of this procedure, to identify the ESCP stages with higher risk of failure, and to evaluate the influence on outcomes of factors related to the endoscopist.

Design

Multicenter retrospective study.

Setting

Public health system hospitals with experience in ESCP in Spain.

Patients

A total of 125 patients underwent ESCP in 19 hospitals, with an experience of <20 procedures.

Intervention

ESCP.

Main Outcome Measurements

Technical success and complication rates in the initial phase of implantation of ESCP are described. The influence of technical characteristics and endoscopist features on outcomes was analyzed.

Results

A total of 125 patients from 19 hospitals were included. Biliary ESCP was performed in 106 patients and pancreatic ESCP was performed in 19. Technical success was achieved in 84 patients (67.2%) followed by clinical success in 79 (63.2%). Complications occurred in 29 patients (23.2%). Unsuccessful manipulation of the guidewire was responsible for 68.2% of technical failures, and 58.6% of complications were related to problems with the transmural fistula.

Limitations

Retrospective study.

Conclusion

Outcomes of ESCP during its implantation stage reached a technical success rate of 67.2%, with a complication rate of 23.2%. Intraductal manipulation of the guidewire seems to be the most difficult stage of the procedure.

Section snippets

Material and methods

In September of 2010, all Spanish endoscopy units with experience in ESCP were contacted and asked to submit clinical, procedural, and operator data for their initial cases. Whereas the total number of ESCPs performed by unit usually was <20, those few units with experience of ≥20 ESCPs were asked to provide data only for their first 20 procedures per endoscopist. Data were pooled into a common database.

Variables regarding patient characteristics included age, sex, diagnosis, and indication for

Results

Twenty hospitals with experience in ESCP were identified and contacted, and only 1 refused to participate. As far as we could ascertain, this represents the complete Spanish experience in ESCP. Only 2 of these hospitals (HRH and HVH) had performed more than 20 ESCP procedures. A total of 125 patients from these 19 hospitals were included. Fifteen centers were tertiary-care hospitals, which contributed 103 patients. Four were community hospitals in which ESCP had been performed in 22 patients. A

Discussion

Since the first description of EUS-guided choledochoduodenostomy by Giovannini et al,8 ESCP has been established as a salvage procedure after failed or impossible ERCP.2, 9 However, it is not yet known how widely disseminated is ESCP. Up to the time of this writing, 23 studies including more than 4 patients referring to biliary ESCP had been published,5, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 with technical success rates ranging from 75% to

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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