title: EUS-guided methylene blue cholangiopancreatography for benign biliopancreatic diseases after failed ERCP.
abstract: OBJECTIVE
  When ERCP fails, EUS-guided interventional techniques may be an alternative. The aim of this study was to evaluate the general outcomes and safety of EUS-guided methylene blue cholangiopancreatography in patients with failed ERCP in benign biliopancreatic diseases.
  
  
  METHODS
  Patients with benign biliopancreatic diseases and failed ERCP were included. EUS-guided cholangiopancreatography plus injection of methylene blue was performed, and then ERCP using coloring agent flow as an indicator of papilla orifice was performed. Procedures were prospectively collected in this observational, single-center study. Technical success, clinical success, and adverse events were analyzed retrospectively.
  
  
  RESULTS
  Eleven patients were included (10 choledocholithiasis, 1 pancreatic stricture). The main reason for failed ERCP was an unidentifiable papilla. EUS-guided ductal access with cholangiopancreatography and papilla orifice identification was obtained in all cases. Technical success and clinical success rates of 91% were achieved, with successful biliopancreatic drainage in 10 patients. Adverse events included 1 peripancreatic abscess attributed to a precut, which was successfully treated. No adverse events were related to the first EUS-guided stage.
  
  
  CONCLUSIONS
  EUS-guided cholangiopancreatography with methylene blue injection seems to be a feasible and helpful technique for treatment in patients with benign biliopancreatic diseases with previous failed ERCP because of an undetectable papilla.
authors.affiliation: Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
authors.forename: Claudia F
authors.initials: CF
authors.lastname: Consiglieri
authors.affiliation: Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain. Electronic address: jgornals@bellvitgehospital.cat.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Gornals
authors.affiliation: Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
authors.forename: Gino
authors.initials: G
authors.lastname: Albines
authors.affiliation: Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: De-la-Hera
authors.affiliation: General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Secanella
authors.affiliation: General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Pelaez
authors.affiliation: General and Digestive Surgery Department, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Catalonia, Spain.
authors.forename: Juli
authors.initials: J
authors.lastname: Busquets
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D042883:Choledocholithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D004396:Coloring Agents; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008751:Methylene Blue; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted; D017211:Treatment Failure
chemical_list: D004396:Coloring Agents; D008751:Methylene Blue