Motomura Douglas, Irani Shayan, Larsen Michael, Kozarek Richard A, Ross Andrew S, Gan S Ian
Division of Gastroenterology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia.
Gastroenterology Section, Digestive Disease Institute, Virginia Mason Franciscan Health, Seattle, Washington, United States.
Endosc Int Open. 2023 Apr 17;11(4):E358-E365. doi: 10.1055/a-2029-2520. eCollection 2023 Apr.
Pancreatic duct (PD) cannulation may be difficult during conventional endoscopic retrograde cholangiopancreatography (ERCP) due to underlying pathology, anatomical variants or surgically altered anatomy. Pancreatic access in these cases previously necessitated percutaneous or surgical approaches. Endoscopic ultrasound (EUS) allows for an alternative and can be combined with ERCP for rendezvous during the same procedure, or for other salvage options. Patients with attempted EUS access of the PD from tertiary referral centers between 2009 and 2022 were included in the cohort. Demographic data, technical data, procedural outcomes and adverse events were collected. The primary outcome was rendezvous success. Secondary outcomes included rates of successful PD decompression and change in procedural success over time. The PD was accessed in 105 of 111 procedures (95 %), with successful subsequent ERCP in 45 of 95 attempts (47 %). Salvage direct PD stenting was performed in 5 of 14 attempts (36 %). Sixteen patients were scheduled for direct PD stenting (without rendezvous) with 100 % success rate. Thus 66 patients (59 %) had successful decompression. Success rates improved from 41 % in the first third of cases to 76 % in the final third. There were 13 complications (12 %), including post-procedure pancreatitis in seven patients (6 %). EUS-guided anterograde pancreas access is a feasible salvage method if retrograde access fails. The duct can be cannulated, and drainage can be achieved in the majority of cases. Success rates improve over time. Future research may involve investigation into technical, patient and procedural factors contributing to rendezvous success.
由于潜在病变、解剖变异或手术改变的解剖结构，在传统内镜逆行胰胆管造影（ERCP）过程中，胰管（PD）插管可能会很困难。在这些情况下，以前需要通过经皮或手术方法来进入胰腺。内镜超声（EUS）提供了一种替代方法，可以与ERCP联合用于在同一手术过程中进行会师，或用于其他挽救方案。纳入了2009年至2022年期间在三级转诊中心尝试通过EUS进入PD的患者队列。收集了人口统计学数据、技术数据、手术结果和不良事件。主要结局是会师成功。次要结局包括PD成功减压的发生率以及手术成功率随时间的变化。111例手术中有105例（95%）成功进入PD，95次尝试中有45例（47%）随后成功进行了ERCP。14次尝试中有5例（36%）进行了挽救性直接PD支架置入术。16例患者计划进行直接PD支架置入术（不进行会师），成功率为100%。因此，66例患者（59%）成功减压。成功率从最初三分之一病例中的41%提高到最后三分之一病例中的76%。有13例并发症（12%），包括7例患者（6%）术后发生胰腺炎。如果逆行进入失败，EUS引导下顺行胰腺进入是一种可行的挽救方法。大多数情况下可以成功插管并实现引流。成功率随时间提高。未来的研究可能包括调查有助于会师成功的技术因素、患者因素和手术因素。
