TY - JOUR
T1 - Endoscopic ultrasound-guided biliary access versus precut papillotomy in patients with failed biliary cannulation
T2 - A retrospective study
AU - Lee, Alexander
AU - Aditi, Anupam
AU - Bhat, Yasser M.
AU - Binmoeller, Kenneth F.
AU - Hamerski, Chris
AU - Sendino, Oriol
AU - Kane, Steve
AU - Cello, John P.
AU - Day, Lukejohn W.
AU - Mohamadnejad, Medi
AU - Muthusamy, V. Raman
AU - Watson, Rabindra
AU - Klapman, Jason B.
AU - Komanduri, Sri
AU - Wani, Sachin
AU - Shah, Janak N.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background and aims: Precut papillotomy is widely used after failed biliary cannulation. Endoscopic ultrasound (EUS)-guided biliary access techniques are newer methods to facilitate access and therapy in failed cannulation. We evaluated the impact of EUS-guided biliary access on endoscopic retrograde cholangiopancreatography (ERCP) success and compared these techniques to precut papillotomy. Patients and methods: We retrospectively compared two ERCP cohorts. One cohort consisted of biliary ERCPs (n =1053) attempted in patients with native papillae and surgically unaltered anatomy in whom precut papillotomy and/or EUS-guided biliary access were routinely performed immediately after failed cannulation. This cohort was compared with a similar ERCP cohort (n =1062) in which only precut papillotomy was available for failed cannulation. The following outcomes were compared: conventional cannulation success, rates of attempted advanced access techniques (precut or EUS), precut success, EUS-guided biliary access success, and ERCP failure rates. Results: Although conventional cannulation success, rates of attempted advanced access technique (precut or EUS), and precut success were similar, the ERCP failure rate was lower when both EUS-guided biliary access and precut were available (1.0 % [95% confidence interval (CI) 0.4-1.6]), compared with when only precut was possible for failed access (3.6% [95%CI 2.5-4.7]; P < 0.001). Success for EUS-guided biliary access (95.1 % [95 %CI 89.7-100]) was significantly higher than for precut (75.3% [95 %CI 68.2-82.4]; P <0.001), and mainly due to superiority in malignant obstruction (93.5 % vs. 64%; P < 0.001). Conclusions: EUS-guided biliary access decreases the rate of therapeutic biliary ERCP failure. Our results support the use of EUSguided biliary access to optimize single-session ERCP success. In experienced hands, these techniques appear as effective, if not more so, than precut papillotomy.
AB - Background and aims: Precut papillotomy is widely used after failed biliary cannulation. Endoscopic ultrasound (EUS)-guided biliary access techniques are newer methods to facilitate access and therapy in failed cannulation. We evaluated the impact of EUS-guided biliary access on endoscopic retrograde cholangiopancreatography (ERCP) success and compared these techniques to precut papillotomy. Patients and methods: We retrospectively compared two ERCP cohorts. One cohort consisted of biliary ERCPs (n =1053) attempted in patients with native papillae and surgically unaltered anatomy in whom precut papillotomy and/or EUS-guided biliary access were routinely performed immediately after failed cannulation. This cohort was compared with a similar ERCP cohort (n =1062) in which only precut papillotomy was available for failed cannulation. The following outcomes were compared: conventional cannulation success, rates of attempted advanced access techniques (precut or EUS), precut success, EUS-guided biliary access success, and ERCP failure rates. Results: Although conventional cannulation success, rates of attempted advanced access technique (precut or EUS), and precut success were similar, the ERCP failure rate was lower when both EUS-guided biliary access and precut were available (1.0 % [95% confidence interval (CI) 0.4-1.6]), compared with when only precut was possible for failed access (3.6% [95%CI 2.5-4.7]; P < 0.001). Success for EUS-guided biliary access (95.1 % [95 %CI 89.7-100]) was significantly higher than for precut (75.3% [95 %CI 68.2-82.4]; P <0.001), and mainly due to superiority in malignant obstruction (93.5 % vs. 64%; P < 0.001). Conclusions: EUS-guided biliary access decreases the rate of therapeutic biliary ERCP failure. Our results support the use of EUSguided biliary access to optimize single-session ERCP success. In experienced hands, these techniques appear as effective, if not more so, than precut papillotomy.
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U2 - 10.1055/s-0042-120995
DO - 10.1055/s-0042-120995
M3 - Article
C2 - 28107764
AN - SCOPUS:85010916164
SN - 0013-726X
VL - 49
SP - 146
EP - 153
JO - Endoscopy
JF - Endoscopy
IS - 2
ER -