462 Contrast-Enhanced Harmonic Ultrasound (CEH-EUS) in Diagnosis of Pancreatic Adenocarcinoma (ADK): Results of the First Multicenter Prospective Study With Intra- and Inter-Observer Concordances Evaluation

Abstract

was either choledocholithiasis or papillary stenosis. In patients undergoing BEAERCP, the roux-en-y anastomosis was identified in 27 of 31 (87.1%). The papilla was identified in 67.7% of BEA-ERCP patients compared to 94.4% in LA-ERCP patients (p 0.031), and cannulation was successful in 54.8% of BEA-ERCP patients compared to 94.4% in LA-ERCP patients (p 0.004). Therapeutic success in BEA-ERCP patients was 54.8% compared to 94.4% in LA-ERCP patients (p 0.004). With either technique, successful cannulation lead to therapeutic success in 100% of cases.The average total procedure time (including surgery) for BEA-ERCP was 102.8 minutes (range 46-180) compared to 180.4 minutes (range 74-284) for LA-ERCP (p 0.001). Looking at endoscopy time alone, the mean endoscopy time was lower for LA-ERCP at 82.2 minutes (range 31-161) than for BEA-ERCP at 102.8 minutes (range 46-180), however statistical significance was not met (p 0.096). The average post-procedure length of hospitalization in subjects with successful BEA-ERCP was 1.29 days (range 1-3) compared to 1.41 days (range 1-4) in subjects with successful LA-ERCP (p 0.693). Of the 14 patients with unsuccessful BEA-ERCP, 10 proceeded to LAERCP, and 9 of those 10 (90%) had therapeutic success with LA-ERCP.The complication rate was 9.7% following BEA-ERCP (mild pancreatitis, transient liver chemistry abnormalities, and moderate abdominal pain) compared to 16.7% following LA-ERCP (enterocutaneous fistula that healed with conservative management, incision pain, and moderate abdominal pain) (p 0.472). Conclusion: LA-ERCP results in significantly higher rates of cannulation and therapeutic success than BEA-ERCP in patients following roux-en-y gastric bypass. Although total procedure time is longer in LA-ERCP, the significant cannulation failure rate and frequent need for a second procedure with BEAERCP, as well as lack of prolonged hospitalization, lack of difference in complication rate, and trend towards shortened endoscopy time in LA-ERCP makes the latter a preferable option in post-bariatric roux-en-y gastric bypass patients who require ERCP.