Original articleClinical endoscopyProspective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP (with video)
Section snippets
Patients and methods
From September 2011 to June 2012, 1350 ERCPs were performed in a 2600-bed, tertiary-care referral hospital by a single experienced endoscopist (D.H.P.) trained in both EUS and ERCP. During this period, 954 cases required biliary decompression for benign or malignant biliary obstruction. During the study period, 40 patients (4.2%) underwent precutting during ERCP because of difficult biliary cannulation. All of these procedures were successful and achieved biliary cannulation. Of the 954
Results
The baseline characteristics are shown in Table 2. The reason for failed ERCP was ampulla of Vater cancer infiltration (n = 8), in duodenal invasion (n = 11), in surgically altered anatomy (n = 14), periampullary diverticulum (n = 7), and 5 in high-grade hilar stricture (n = 5). The number of cases of surgically altered anatomy in this study was pylorus-preserving pancreaticoduodenectomy (n = 5), Whipple procedures (n = 2), Roux-en-Y anastomosis with hepaticojejunostomy (n = 4), total
Discussion
Research to date on EUS-guided biliary drainage can be classified into EUS-guided rendezvous-based or transluminal stenting–based studies (Table 5).1, 7, 8, 11, 13, 15, 22, 23, 24, 25, 26 After failed ERCP, these procedures may be selected according to the expertise of the endoscopist involved and the feasibility of each technique. Thus, no unified or widely accepted treatment algorithm for EUS-BD was available. Recently, a retrospective study on the EUS-guided antegrade therapy–based protocol
Acknowledgments
The authors are indebted to Steven A. Edmundowicz, MD, FASGE (Washington University School of Medicine) for his helpful comments and critical revision of this manuscript.
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DISCLOSURE: All authors disclosed no financial relationship relevant to this publication.
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Drs Park and Jeong contributed equally to this article.