Introduction ERCP should be considered as a therapeutic modality in the vast majority of cases but some patients may have to wait for the appropriate diagnostic test. Endoscopic ultrasound (EUS) can be used to detect pancreaticobiliary pathology especially in situations where cross sectional imaging techniques have reduced accuracy (eg, <10 mm bile duct stones). When such pathology is identified, same session ERCP theoretically could be performed but there is limited data on safety, patient comfort and complications. The aim of this study was to evaluate a recent service development whereby EUS can be immediately followed by ERCP.
Methods Our unit performs around 350 ERCP's and 250 EUS procedures per annum. Since April 2011, there has been facility to perform EUS on the ERCP lists. All referrals are vetted and if deemed appropriate are listed for EUS ± ERCP on the same list. All patients listed for both procedures had their notes reviewed and demographics, indication, sedation requirements, comfort scores, need for ERCP and final diagnosis recorded. Median pethidine dose, midazolam dose and comfort scores were compared in those who EUS and ERCP vs EUS alone.
Results During the period April 2011–December 2011, 34 patients (median age 72 years) were listed for EUS ± ERCP. Indications for EUS prior to ERCP included dilated ducts (n=13), abnormal enzymes (n=10), other imaging unclear (n=4), possible sphincter of Oddi dysfunction (n=3), fine needle aspiration (n=4). 10/34 (29.4%) patients did not undergo subsequent ERCP as the EUS showed no indication. 16 were found to have bile duct stones, 4 had a neoplasm, 3 had sphincter of Oddi dysfunction and 1 a pancreatic duct stone (all confirmed at ERCP). There were no differences in demographics or indication in patients undergoing EUS and ERCP vs EUS alone. Median midazolam doses were significantly higher in those undergoing both procedures (4 mg vs 3 mg, p=0.002) not median pethidine dose (25 mg vs 25 mg, p=0.12) or comfort scores (1.0 vs 1.0, p=0.25). At ERCP, 18 patients underwent sphincterotomy and duct trawl, five patients had a stent inserted and one patient underwent choledochoscopy. No complications occurred in either group.
Conclusion EUS and ERCP can be performed safely in the same session but patients often need extra sedation for the second procedure. This does not appear to be detrimental to patients comfort or associated with an increased complication rate. A larger cohort should be examined prospectively and include analysis of list dynamics, cost effectiveness and patient preference.
Competing interests None declared.
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