Endoscopy 2019; 51(04): S97
DOI: 10.1055/s-0039-1681455
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 08:30 – 10:30: EUS therapeutic bile South Hall 1B
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC ULTRASOUND-GUIDED RENDEZVOUS IN BENIGN BILIARY OR PANCREATIC DISORDERS WITH A 22-GAUGE NEEDLE AND A 0.018-INCH NOVAGOLD GUIDEWIRE

B Martínez
1   Hospital Universitario del Vinalopó, Elche, Spain
,
J Martínez
2   Hospital General Universitario de Alicante, Alicante, Spain
,
C Mangas-San Juan
2   Hospital General Universitario de Alicante, Alicante, Spain
,
M Bozhychko
2   Hospital General Universitario de Alicante, Alicante, Spain
,
JA Casellas
2   Hospital General Universitario de Alicante, Alicante, Spain
,
J Ramón Aparicio
3   Unidad de Endoscopia, Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

To assess the efficacy and safety of endoscopic ultrasound-guided rendezvous (EUS-RV) for benign biliary or pancreatic disorders with a 22-gauge needle and a 0.018-inch guidewire.

Methods:

Retrospective study of patients who underwent EUS-RV after failed biliary or pancreatic cannulation for benign disorder. For EUS-RV, a 22-gauge needle and a 0.018-inch Novagold guidewire were used. The primary outcome was the technical success rate and the secondary outcome was the rate of adverse events.

Results:

Thirty-one patients were included (18 men and 13 women, average age (SD) of 71.8 (13.1) years. In 27 cases, the EUS-RV was biliary, and in 4 cases, it was pancreatic. Initial ERCP was performed for bile duct stones (n = 20), benign stenosis (n = 5), biliary leak (n = 2), pancreatic stenosis (n = 1), pancreatic fistula (n = 1), and the treatment of intraductal lithiasis in chronic pancreatitis (n = 2). Twenty-five (80.6%) patients underwent EUS-RV in the same session after failed ERCP. The reasons for applying EUS-RV were undetectable papilla (n = 3), intradiverticular papilla (n = 9), and failed cannulation (n = 19).

Duct puncture and contrast injection were achieved with the 22-gauge needle in all cases. However, the guidewire could be placed only in the duodenum in 25/31 (80.6%), completing the procedure in all cases in which the guide was passed, which represents a technical and clinical success rate of 80.6%. In pancreatic EUS-RV, the technical success rate was 75% (3/4), and in biliary, it was 81.5% (22/27), p = 0.76. The overall adverse event rate was 12.9% (4 adverse events in 3 patients), all of which were in biliary EUS-RV.

Conclusions:

EUS-RV may be a safe and feasible salvage method for unsuccessful cannulation for benign disorders. The use of a 22-gauge needle with a 0.018-inch guidewire may be the first option for benign pathology.