Endoscopy 2019; 51(04): S155-S156
DOI: 10.1055/s-0039-1681628
ESGE Days 2019 ePoster podium presentations
Friday, April 5, 2019 14:00 – 14:30: EUS therapeutic bile ePoster Podium 5
Georg Thieme Verlag KG Stuttgart · New York

PAPILLA CANNULATION USING HOME-MADE MONORAIL SPHINCTEROME AFTER EUS-GUIDED RENDEZVOUS TECHNIQUE

M Bozhychko
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
,
C Mangas-Sanjuan
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
,
L Compañy
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
,
FA Ruiz
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
,
J Martínez Sempere
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
,
JA Casellas
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
,
J Ramón Aparicio
1   Unidad Endoscopias, Hospital General Universitario de Alicante, Alicante, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

When endoscopic retrograde cholangiopancreatography (ERCP) fails, EUS-guided rendezvous technique (EUS-RV) is an effective alternative. However, guidewire extraction through the duodenoscope is time-consuming and has some complications.

To assess the efficacy of papilla cannulation using a home-made monorail sphincterotome over a guidewire after EUS-RV.

Methods:

We report a prospective cohort study of biliary-pancreatic EUS-RV conducted in a tertiary Spanish center from June 2017-September 2018. Two cohorts were compared: one with traditional papilla cannulation after EUS-RV and one with papilla cannulation using home-made monorail sphincterotome. Monorail sphincterotome was made using the same sphincterotome when ERCP failed, by using a scalpel to make a 2 – 3 mm slot in the convex part of the distal end of the sphincterotome.

Results:

A total of 33 cases (21 men/12 women, mean age 75.4 years) were included: four cases of pancreatic EUS-RV and twenty-nine biliary EUS-RV. In regards to procedure indication: 10 patients with malignant stenosis, 13 with choledocholithiasis, 6 with benign biliary stenosis, 2 with pancreatic stenosis, 2 with intraductal lithiasis. NovaGold 0.018" guidewire was used in 19 cases while Visiglide 0.025" guidewire in 14 cases. Technical success to cannulate the papilla using monorail sphyncterotome was 30/33 cases (91%). Median (P25-P75) duration of EUS-RV using monorail sphincterotome was significantly lower compared to traditional method: 32 (25 – 38) vs. 59 (51 – 66)min, p = 0.0003. There weren't differences in technical success of papilla cannulation with monorail sphincterotome regarding indication (malignant stenosis vs. other causes: 100% vs. 87%, p = 0.32), type of guidewire (NovaGold vs. Visiglide: 89.5% vs. 92.9%, p = 0.61), type of EUS-RV (biliary vs. pancreatic: 93.1% vs. 75%, p = 0.33) or dilatation of biliary tract (yes vs. no: 100% vs. 89%, p = 0.37).

Conclusions:

The use of home-made monorail sphincterotome over the guidewire for papilla cannulation after EUS-RV, significantly shortens the duration of the procedure compared to traditional methods.