EUS and ERCP at same session: is it always a good idea?

Aims Historically, EUS and ERCP were considered separate procedures. However, in the last decade, their combined execution in the same session has gained popularity, leading to the emergence of bilio-pancreatic endoscopy. This study aimed to evaluate the efficacy and safety of same-session EUS-ERCP (SSEE) compared to two-session EUS-ERCP (TSEE) in treating choledocholithiasis and distal malignant biliary strictures.

Methods We retrospectively analyzed consecutive patients treated between January 2021 and December 2023 at an Italian tertiary referral center. Patients undergoing EUS and ERCP for choledocholithiasis or obstructive jaundice caused by malignant distal CBD strictures were divided in two groups “same session EUS and ERCP group” (SSEE) and “two sessions EUS and ERCP group” (TSEE). We compared procedural ERCP success, major adverse events (such as post-ERCP acute pancreatitis, early or delayed bleeding, duodenal or biliary perforation), and other conventional procedure-related variables between the two groups.

Results A total of 200 patients (103 males, 97 females; mean age: 71 years) were included in the study, with 100 patients in each group.

No statistically significant difference between the two groups was recorded in terms of ERCP overall success (95% vs 99%; p=n.s.) and cannulation rates both with guidewire-assisted technique (51.9% vs 48%; p=n.s) and through the use of precut (45.6% vs 56.4%: p=n.s.). In the TSEE group, we observed higher success in CBD stone extraction (41% vs 58%; p=0.03), while the SSEE group achieved a higher frequency of sequential and immediate stenting (63.3% vs 36.7%; p=0.01), especially for neoplastic strictures. The total procedure time (EUS+ERCP) was comparable between the groups (71.4 min vs. 75.05 min; p=n.s.). By contrast, a mean 3-day gain in terms of hospital stay was observed in the SSEE group. Also major adverse events occurred at similar rates in both groups (7% vs. 10%; p=n.s.).

Conclusions Our single-center experience confirms that both SSEE and TSEE are safe and effective strategies for managing patients requiring EUS and ERCP. Each approach has distinct advantages tailored to specific clinical scenarios: SSEE appears to be more cost-effective, with shorter hospital stays, for patients with neoplastic strictures requiring stenting; TSEE, instead, seems to provide procedural advantages for patients with choledocolithiasis. Therefore, the choice between SSEE and TSEE should be guided by patient characteristics and disease-specific factors to optimize outcomes.

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Artikel online veröffentlicht:
27. März 2025