Troubles pancréatiques et thérapie
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Traversibility to the Papilla Decides the Feasibility of EUS-guided Cholangio-Pancreatic Access for Patients with Difficult Biliary Cannulation

Kensuke Kubota, Yuji Fujita, Takamtsu Sato, Seitaro Watanabe, Yusuke Sekino, Kunihiro Hosono et Atsushi Nakajima

Background: EUS-guided direct cholangio-pancreatic access (EUS-DCP) may be useful in cases with an inaccessible papilla, however, it is challenging due to the technical difficulty and high complication rate. EUS-rendezvous for antegrade cholangio-pancreatography (EUS-RV) also is feasible in these patients.

Aims: To evaluate the indications, feasibility and safety of the EUS-DCP/RV in our case series.

Methods: The success and complication rates were analyzed and compared between patients undergoing EUSDCP and those undergoing EUS-RV.

Results: Sixteen patients underwent EUS-DCP, including EUS-hepatogastrostomy in four and EUScholedochduodenostomy in twelve patients. Six patients underwent EUS-RV, including two patients who required double–metallic stent deployment for malignant biliary and duodenal obstruction, one with ampullary cancer, two with chronic pancreatitis and one with papillary stricture due to the ampullectomy. The success rate was 62.5% (10/16) in the EUS-DCP group and 100% (6/6) in the EUS-RV group. The complication rate was 33% in the EUS-DCP group and 0% in the EUS-RV group, respectively.

Conclusions: Although the feasibility of EUS-DCP or EUS-RV depends on the traversibility to the papilla, EUS-RV, rather than EUS-DCP, appears to be more feasible and safe, and may represent the modality of first choice for patients with an inaccessible papilla.