Su1429 Frozen Section of ERCP Forceps Biopsy Specimens Permits Efficient Intraprocedural Diagnosis

Abstract

Same Session, Single-Operator EUS-Assisted Cholangiopancreatography (EUSCP) After Failed ERCP: Expanded Experience Jay P. Babich, James H. Grendell, Stavros N. Stavropoulos Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, NY ERCP fails to access the biliary or pancreatic ductal systems in 1-2% of patients. EUSCP is being increasingly employed at expert centers as an alternative to surgery or interventional radiology, modalities which until recently provided the only alternatives to failed ERCP access. Methods: All patients had EUSCP after initial ERCP attempt at our center by one of the investigators with a career ERCP volume of 3000 ERCPs(SS). The EUSCP was performed at the same session as failed ERCP in the majority of cases. Technical success was defined as successful access of the desired duct as a result of EUSCP. Clinical success was defined as lack of need for alternative intervention. Results: From 1/2004 to 11/2010, 30 patients (22F,mean age 61) underwent EUSCP for biliary access (n 23) or pancreatic access (n 7). EUSCP was performed at the same session as failed ERCP attempt in 21/23 (91%)biliary patients and 5/7 (71%) pancreatic patients. Biliary indications: periampullary diverticulum (n 2), periampullary tumor infiltration (n 12), hilar metal stent obstructing the L system (n 1), post-surgical complications/altered anatomy (n 7), duodenal malrotation (n 1). Pancreatic indications: post Whipple stricture (n 2), unsuccessful minor papilla cannulation (n 2), migrated pancreatic stent (n 2), pancreatogastric anastomosis stricture (n 1).BD interventions included: Transgastric hepatic stent placement (n 8), transduodenal stent placement (n 3), rendezvous (n 8), antegrade transpapillary stent placement (n 1), cholangiography guided retrograde stent placement (n 2), cholangiography to map biliary tree prior to biliary surgery for transected CHD (n 1). Pancreatic interventions included: Rendezvous for post Whipple stricture (n 2), minor papilla rendezvous (n 1), antegrade rendezvous to assist retrieval of embedded stent (n 1), Direct EUS guided transgastric extraction of migrated PD stent in OR with laparoscopic assistance (n 1), pancreatography guided minor papilla cannulation (n 1), other (n 1). Biliary intervention technical success was 22/23 (96%) with clinical success in 21/22 pts (92%). Pancreatic intervention technical and clinical success was 3/7 (43%). Biliary complications (2/23; 9%)were; self-limited hemobilia after successful rendezvous and pneumoperitoneum after transgastric hepatic plastic stent. Pancreatic complications (2/7; 29%) were mild pancreatitis after successful pancreatic rendez-vous. Conclusions: 1) EUSCP by a single operator at the same session as failed ERCP appears feasible, with a high success rate and a low complication rate. Technical success appears higher for biliary cases. 2) Prospective multicenter data collection would be useful in confirming the results of single center expert series. 3) Complications tend to occur early in operator experience consistent with the high level of expertise required for EUSCP.