Outcomes of endoscopic-ultrasound-guided cholangiopancreatography: a literature review

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) can fail in 3-10% of the cases even in experienced hands. Although percutaneous transhepatic cholangiography (PTC) and surgery are the traditional alternatives, there are morbidity and mortality associated with both. In this paper, we have discussed the efficacy and safety of endoscopic-ultrasound-guided cholangiopancreatography (EUS-CP) in decompression of biliary and pancreatic ducts. The overall technical and clinical success rates are around 90% for biliary and 70% for pancreatic duct drainage. The overall EUS-CP complication rate is around 15%. EUS-CP is, however, a technically challenging procedure and should be performed by an experienced endoscopist skilled in both EUS and ERCP. Same session EUS-CP as failed initial ERCP is practical and may result in avoidance of additional procedures. With increasing availability of endoscopists trained in both ERCP and EUS, the role of EUS-CP is likely to grow in clinical practice.

Figure 1

Transluminal stenting in a patient with metastatic breast cancer with extrahepatic biliary and duodenal obstruction. (a) Initial Cholangiogram using 22-gauge needle via transduodenal approach. (b) Choledochoduodenostomy tract dilation with 7–10 Fr dilating catheter. (c) Placement of a 10 Fr × 6 cm double-pigtail plastic stent. (d) Placement of a 22 × 60 mm uncovered enteral stent.

Figure 2

Transluminal stenting in a patient with common hepatic duct transection post-cholecystectomy. (a) Complete iatrogenic CHD obstruction at the site of cholecystectomy clips. (b) Initial cholangiogram with a 19-gauge needle via transgastric approach with passage of 0.025′′ guidewire. (c) Placement of two 10 × 80 mm partially covered SEMS. (d) Placement of a 7 Fr × 12 cm double-pigtail plastic stent inside metal stents to prevent outmigration.

Figure 3

Transluminal stenting in a patient s/p central pancreatectomy with pancreaticogastrostomy obstruction. (a) Initial pancreatogram. (b) Passage of a 0.025′′ guidewire. (c) Pancreaticogastrostomy tract dilation with 6 mm dilation balloon. (d) Placement of a 8 × 60 mm fully covered SEMS followed by 7 Fr × 7 cm single-pigtail plastic stents placement.