1. EUS-guided methylene blue cholangiopancreatography for benign biliopancreatic diseases after failed ERCP
- Author
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Claudia F. Consiglieri, Joan B. Gornals, Meritxell de-la-Hera, Núria Peláez, Juli Busquets, Gino Albines, and Lluis Secanella
- Subjects
Adult ,Male ,medicine.medical_specialty ,Constriction, Pathologic ,Clinical success ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Prospective Studies ,Treatment Failure ,Stage (cooking) ,Coloring Agents ,Abscess ,Adverse effect ,Prospective cohort study ,Aged ,Aged, 80 and over ,Cholangiopancreatography, Endoscopic Retrograde ,Pancreatic duct ,business.industry ,Pancreatic Ducts ,Gastroenterology ,Pancreatic Diseases ,Middle Aged ,medicine.disease ,digestive system diseases ,Surgery ,Methylene Blue ,Major duodenal papilla ,Choledocholithiasis ,medicine.anatomical_structure ,Surgery, Computer-Assisted ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,business - Abstract
Background and Aims 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. Conclusion 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.
- Published
- 2016