Abstract
choledocolithiasis (9), pancreatolithiasis (6), pancreatic duct stenosis (4) and other (3). ESCP was performed for malignant disease in 53 patients (69%). ERCP was not possible for difficult cannulation in 52 patients (67%) or an inaccessible ampulla in 25 patients (33%). Biliary and pancreatic drainage were attempted in 66 (86%) and 11 (14%) patients respectively, with a transgastric approach in 43 (56%) and transduodenal in 34 (44%). Ductography was achieved in 71/77 patients (92%), introduction of a wire into the biliary or pancreatic duct in 70/71 patients (98%), successful intraductal wire manipulation in 56/70 patients, rendezvous in 19/33, fistula dilation in 38/44 and transmural stent deployment in 31/38 patients. Technical success was achieved in 48 patients (62%) with clinical success in 45 of them. Intraductal wire manipulation was the most limiting stage and caused 16/29 failures. Complications occurred in 14 patients (18%) and as a direct consequence of them 4 patients passed away. Technical success was significantly better for endoscopists who performed more than 5 ESCP (75% vs 41%, p 0.004) and when the procedure was performed by 2 endoscopists (74% vs 52%, p 0.04). Other comparisons did not show a statistically significant influence on the final result. CONCLUSIONS: According to our data, outcomes of ESCP during its implantation stage in both community and referral hospitals reach a technical success of 62% with a complication rate of 18%. Intraductal manipulation of the wire seems to be the most difficult stage of the procedure. An experience of more than 5 ESCP and performance of the procedure by 2 endoscopists are factors which significantly improve the technical success of ESCP.
Published Version
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