Division of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA.
Gastrointest Endosc. 2010 Jun;71(7):1166-73. doi: 10.1016/j.gie.2009.10.048. Epub 2010 Mar 19.
Cannulation of the pancreatic duct (PD) during endoscopic retrograde pancreatography (ERP) can fail even in experienced hands. A technique for therapeutic EUS-assisted rendezvous ERP has been described in a few case reports.
To investigate the efficacy and safety of therapeutic EUS-assisted ERP.
Retrospective study.
Tertiary-care medical center.
This study involved 21 patients after failed ERP.
EUS-guided transgastric pancreatography by using a mixture of contrast media and methylene blue was attempted. If that was successful, ERP was attempted by using methylene blue flow as an indicator of the PD orifice or by a rendezvous technique using a wire passed into the PD and the small bowel through the EUS needle.
Technical success rate and complications.
The PD was of a normal diameter in 7 patients and was dilated in 14 patients. EUS-guided pancreatography was successfully done in all patients with a dilated PD but only in 4 of 7 patients (57%) with normal-diameter PDs. In 6 patients, ERP was successfully performed by using methylene blue flow as an indicator of the PD orifice. The rendezvous technique was successful in 4 of 12 cases (33%), and reasons for failure were either a tight stricture (n = 5) or a suboptimal angle of EUS needle insertion (n = 3). Overall, EUS-assisted ERP was successful in 10 of 21 patients (48%). Complications included peripancreatic abscess in 1 patient and mild pancreatitis in 1 patient.
Retrospective study, small sample size.
EUS-assisted ERP is a complex procedure that can provide access to the PD in selected cases after failed standard ERP.
即使在有经验的手中，内镜逆行胰胆管造影术（ERP）期间的胰管（PD）插管也可能失败。已经在少数病例报告中描述了一种用于治疗性超声内镜辅助会师 ERP 的技术。
研究治疗性超声内镜辅助 ERP 的疗效和安全性。
回顾性研究。
三级医疗中心。
这项研究涉及 21 例 ERP 失败后的患者。
尝试通过使用造影剂和亚甲蓝的混合物进行超声内镜引导下经胃胰管造影。如果成功，尝试使用亚甲蓝流作为 PD 口的指示物进行 ERP，或通过将导丝穿过 EUS 针进入 PD 和小肠的会师技术进行。
技术成功率和并发症。
7 例 PD 直径正常，14 例 PD 扩张。所有扩张 PD 的患者均成功进行了超声内镜引导下的胰管造影，但仅 7 例 PD 正常直径的患者中的 4 例（57%）成功。在 6 例患者中，通过使用亚甲蓝流作为 PD 口的指示物成功进行了 ERP。会师技术在 12 例中的 4 例（33%）中成功，失败的原因是紧密的狭窄（n=5）或 EUS 针插入角度不理想（n=3）。总的来说，21 例患者中有 10 例（48%）通过超声内镜辅助 ERP 成功。并发症包括 1 例胰周脓肿和 1 例轻度胰腺炎。
回顾性研究，样本量小。
在某些情况下，超声内镜辅助 ERP 是一种复杂的程序，可以在标准 ERP 失败后提供通向 PD 的途径。
