S58 Endoscopic Retrograde Cholangiopancreatography After Pancreaticoduodenectomy and the Utility of Rigidizing Overtube in Improving Procedural Success – A Tertiary Cancer Center Experience

Abstract

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge in patients with a pancreaticoduodenectomy (PD). Advances in endoscopic technology may improve success of the ERCP after PD. Herein we report outcomes of ERCP after PD at a tertiary cancer center. We also summarize our experience with the use of a novel rigidizing overtube (RO) for ERCP post- PD. Methods: We performed retrospective review of patients with prior classic or pylorus-preserving PD who underwent ERCP with Pathfinder use at MD Anderson Cancer Center from 2006 to 2021. Outcomes included technical success (TS) rate, which was defined as successful cannulation of biliary tree and treatment of stricture with dilation or stent placement when applicable, and clinical success (CS) rate, defined as improvement in patient symptomatology with or without normalization of bilirubin level. Results: A total of 48 patients underwent 102 ERCPs; RO was used in 11 procedures (Table). ERCP was most commonly done for cholangitis in index and repeat cases. In cases where RO was used, 63.6% had biliary obstruction without cholangitis. TS was achieved in 81% of cases without RO and 91% cases with RO. Stent placement was done in 60% and 64% of cases without and with RO, respectively. The CS rate was 67%% and 100% of cases without and with RO, respectively. The overall adverse event rate was 5%. All adverse events occurred in cases where no RO was used, with an adverse event rate of 6% in cases without RO used; no complications were noted in the RO cases. Conclusion: ERCP after PD, despite being technically challenging, carries a favorable success rate. TS of ERCP after PD may be improved with use of RO based on our limited experience. There is a need of randomized controlled trials to further ascertain the utility of RO in improving TS and CS of ERCP in surgically altered anatomy. (Figure)Figure 1.: ERCP After Pancreaticoduodenectomy: Patient Characteristics and Indication for ERCP Table 1. - ERCP Results ERCP without Rigidizing Overtube ERCP with Rigidizing Overtube Technical Success, n (%) 74/91 (81.0%) 10/11 (90.9%) Clinical Success, n (%) 57/85 (76.2%) 10/10** (100.0%) Adverse Events, n (%) 5/91 (6.0%) 0/11 (0.0%) Post-procedure Fever, n (%) 4/5 (80.0%) - Cholangitis, n (%) 1/5 (20.0%) - **No follow-up data available for 1 case.