Therapeutic Efficacy and Safety Profile of Endoscopic Ultrasound (EUS) Guided Opacification, Cannulation and Therapy of the Common Bile Duct (CBD) and Wirsung (PD)

Background: Several retrospective uncontrolled case series of patients have been published in recent years, with results supporting EUS may be an excellent aid for CBD and pancreas/PD therapy (tumors/stones/chronic pancreatitis) when either ERCP has failed or is not feasible. Aim: To assess the therapeutic efficacy and safety profile of EUS guided biliary and pancreatic therapy. Methods: 01/05-08/08. Inclusion Criteria: 1.) Patient with billiary/pancreatic pathology in which endoscopic therapy is indicated and ERCP has failed or is not feasible. Exam: CBD or PD was identified, punctioned and contrasted with an EUS-FNA 19-Gauge needle; a 0.021-0.035 inches guide wire was introduced in the CBD/PD and advanced until the desired place was reached (duodenum/PD/CBD). For Rendez vous technique the guide wire was advanced till the dudedenum was reached and the exam was continued with a duodenoscope. Results: From a total of 3628 EUS exams, 12 consecutive patients meeting inclusion criteria, have been included in this study. (Y: Yes; N: No; N.A.: Not Applicable) (Table). Clinical success was achieved in: A.) EUS-FNA of CBD/PD: 12/12=100%. B.) Colangio/pancreatogram by EUS-FNA: 12/12=100%. C.) Advance the guide wire to the desired place: 8/12=66.6%. D.) Therapeutic success (EUS/ERCP): 7/12=58.3%. Complications registered in 3/12=25% (peritoneum bile leak, pancreatitis, colangitis). Conclusions: EUS-FNA allows one to identify, punction and contrast the CBD/PD in different clinical indications. Advancing the guide wire until the desired place is reached or placing a stent for therapeutic purposes may be more difficult. The complication rate associated with this type of interventions may be clinically significant. Tabled 1 Baseline disease (CP: Chronic pancreatitis) Approach (TG/TD) (Transgastric/TransDuodenal) FNA/ Cholangio Pancreatogram Wire Stent CP & prev surg (n=1) TG for PD stent Y/Y N N CP & Pancreas stones (n=2) TG for páncreas rendez vous Y/Y Y N.A. Pancreas CA (n=1) TD for CBD stent Y/Y Y Y Pancreas CA & prev surg (n=1) TG for CBD stent Y/Y Y Y Pancreas CA (n=2) TG for CBD rendez vous Y/Y N N.A. CBD Stones (n=2) TG for CBD rendez vous Y/Y Y N.A. CBD Stones (n=1) TD for CBD rendez vous Y/Y Y N.A. Pancreas CA (n=2) TD for CBD rendez vous Y/Y N N.A. Open table in a new tab