CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(03): E368-E376
DOI: 10.1055/a-1070-8749
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

Bimodal ERCP, a new way of seeing things

Marcus Reuterwall
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
2  Ersta Hospital – Surgery, Stockholm, Sweden
,
Alexander Waldthaler
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
3  Karolinska University Hospital – Upper Abdominal Diseases, Stockholm, Sweden
,
Jeanne Lubbe
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
4  University Stellenbosch – Division of Surgery, Stellenbosch, Western Cape, South Africa
,
Nils Kadesjö
5  Karolinska University Hospital – Medical Radiation and Physics and Nuclear Medicine, Stockholm, Sweden
,
Raffaella Pozzi Mucelli
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
6  Karolinska University Hospital – Abdominal Radiology, Stockholm, Sweden
,
Marco Del Chiaro
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
,
Matthias Lohr
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
,
Urban Arnelo
1  Karolinska Institute, CLINTEC, Stockholm, Sweden
3  Karolinska University Hospital – Upper Abdominal Diseases, Stockholm, Sweden
› Author Affiliations
Further Information

Publication History

submitted 26 June 2019

accepted after revision 04 November 2019

Publication Date:
21 February 2020 (online)

Abstract

Background and study aims Conventional endoscopic retrograde cholangiopancreatography (ERCP) is hampered by two-dimensional visualization, post-procedural adverse events (AEs), and exposure to ionizing radiation. Bimodal ERCP might mitigate these challenges, but no reports of its use are available to date. The aim of this study was to explore the feasibility of bimodal ERCP, while investigating its potential clinical yield.

Patients and methods This was a retrospective observational study of patients that underwent bimodal ERCP in a single tertiary academic referral center. Thirteen patients undergoing conventional ERCP had a previously T2-weighted isotropic 3 D TSE MRCP sequence aligned and fused with the two-dimensional image generated from the fluoroscopy c-arm unit in real time.

Results Over a 2-month period, 13 patients with a mean age of 54 underwent bimodal ERCP for bile duct stricture (61.5 %), complex cholelithiasis (7.7 %) and ductal leakage (30.1 %). Bimodal ERCP was feasible in all 13 cases, and image quality was assessed as “good” in 11 patients (84.6 %). Bimodal ERCP aided in visualizing the lesion of interest (76.9 %), assisted in understanding the 3 D anatomy of the biliopancreatic ductal system (61.5 %), and aided in finding a favorable position for the c-arm (38.4 %) for subsequent therapeutic intervention.

Conclusions This first report on bimodal ERCP proves its feasibility and suggests that it may assist in increasing both the diagnostic and therapeutic yield of ERCP, while at the same time decreasing AEs during and after ERCP. Its main application might lie in treatment of complex intrahepatic disease.