title: Single-operator EUS-guided cholangiopancreatography for difficult pancreaticobiliary access (with video).
abstract: BACKGROUND
  When conventional ERCP methods fail because of periampullary or ductal obstruction, EUS-guided cholangiopancreatography (EUS-CP) may aid in pancreaticobiliary access.
  
  
  OBJECTIVE
  To report our experience when using single-operator EUS-CP.
  
  
  METHODS
  An academic tertiary-referral center.
  
  
  METHODS
  Consecutive patients undergoing EUS-CP were prospectively identified. These patients had undergone failed attempt(s) at therapeutic ERCP. A data sheet was used to record indications, reasons for failed ERCP, EUS-CP visualization of the duct of interest, transpapillary or transenteric intervention, clinical follow-up, and complications.
  
  
  METHODS
  Technical success was decompression of the duct of interest. Clinical success was resolution of jaundice or a > or = 50% reduction in pain or narcotics, as applicable.
  
  
  RESULTS
  Between February 2003 and June 2007, EUS-CP was attempted in 20 patients (11 men, 9 women; mean [SD] age 58 +/- 14.9 years). Indications included jaundice (n = 8), biliary stones (n = 3), chronic pancreatitis (n = 6), acute pancreatitis (n = 2), and papillary stenosis (n = 1). Reasons for failed ERCP included periampullary mass (n = 8), intradiverticular papillae (n = 4), and pancreatic duct (PD) stricture (n = 7) or stone (n = 1). Technical success was achieved in 18 of 20 patients (90%). Biliary decompression was obtained in 11 of 12 patients (92%) (7 transpapillary and 4 transenteric-transcholedochal). Pancreatic decompression was obtained in 7 of 8 patients (88%) (3 transpapillary, 4 transgastric). On follow-up, clinical improvement was noted in 15 of 20 patients (70%). For treatment of pain associated with chronic pancreatitis, pain scores decreased by a mean of 1.75 (P = .18). Complications (in 2 of 20 [10%]) included perforation (n = 1) and respiratory failure (n = 1).
  
  
  CONCLUSIONS
  A single-center nonrandomized observational study with a small patient population.
  
  
  CONCLUSIONS
  At our academic referral center, single-operator EUS-CP provided decompression of obstructed ducts and may be performed after a failed attempt at conventional ERCP during the same endoscopic session.
authors: Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Denver, Aurora, Colorado 80045, USA.
authors: Brian C
authors: BC
authors: Brauer
authors: Yang K
authors: YK
authors: Chen
authors: Norio
authors: N
authors: Fukami
authors: Raj J
authors: RJ
authors: Shah
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D014741:Video Recording