Controversies in ERCP: Indications and preparation

Dietrich, Christoph F.; Bekkali, Noor; Burmeister, S.; Ye, Dong; Everett, Simon; Hocke, Michael; Ignee, A.; On, Wei; Hebbar, Srisha; Oppong, Kofi; Sun, Siyu; Jenssen, Christian; Braden, Barbara

doi:10.4103/eus-d-21-00106

Cited by 3 publications

(2 citation statements)

References 128 publications

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“…The decision process surrounding if and when to perform an ERCP in a given patient often involves an interplay between multiple providers, comprising inpatient and outpatient care teams [ 8 ]. The specific mix of clinical teams involved in a patient’s care depends on a given patient’s medical co-morbidities and the tempo, characteristics, and severity of symptoms that led to the patient’s clinical presentation [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

The Majority of Patients Who Undergo ERCP When Large Duct Obstruction Is Evident on Liver Biopsy Have Biliary Findings Amenable to Endoscopic Intervention

Martin

Lee

Gugig

et al. 2023

JCM

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(1) Background: Abnormal liver function tests are commonly encountered in clinical practice, often leading to additional workup to determine the underlying etiology of these abnormal laboratory studies. As part of this evaluation, if less invasive imaging studies are performed and are without evidence of biliary obstruction, liver biopsy may be performed, and the finding of large duct obstruction on liver biopsy is commonly encountered. The utility of endoscopic retrograde cholangiopancreatography (ERCP) for evaluation and management of possible biliary obstruction in patients with large duct obstruction on liver biopsy has not been studied to date. (2) Methods: To assess the utility of ERCP in patients with large bile duct obstruction on liver biopsy, we retrospectively evaluated patients with large duct obstruction on liver biopsy from 2010–2019 at our tertiary care and transplant center. Demographic and clinical characteristics were evaluated for all patients, with sub-group analysis for patients who underwent ERCP and those who had intervenable findings at the time of ERCP. Descriptive statistics with proportions, means, and standard deviations were performed for demographics and clinical variables using absolute standardized difference. (3) Results: During the study period, 189 liver biopsies with evidence of large duct obstruction were performed. After exclusion criteria were applied, 166 unique patients were eligible for the study. Ninety-one patients with evidence of large duct obstruction on liver biopsy underwent ERCP and 75 did not. Of the 91 patients who underwent ERCP, 76 patients (84%) had an intervenable finding at ERCP. Patients who underwent ERCP were overall more likely to have had a liver transplant (65% ASD 0.63), have previously undergone cholecystectomy (80%, ASD 0.56), and be immunocompromised (80%, ASD 0.56). (4) Conclusions: ERCP is high yield when large duct obstruction is apparent on liver biopsy, with the majority of patients (84%) who undergo ERCP in this clinical context having a biliary finding necessitating therapeutic endoscopic intervention.

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Section: Discussionmentioning

confidence: 99%

The Majority of Patients Who Undergo ERCP When Large Duct Obstruction Is Evident on Liver Biopsy Have Biliary Findings Amenable to Endoscopic Intervention

Martin

Lee

Gugig

et al. 2023

JCM

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“…The technique, interpretation and procedure all favor EUS being performed by an experienced ERCP endoscopist [48,49]. The technique of performing EUS in the duodenum with side-viewing instruments needs experience that can be achieved by training similar movements with duodenoscopes.…”

Section: Arguments In Favormentioning

confidence: 99%

Controversies in Endoscopic Ultrasound-Guided Biliary Drainage

Dietrich,

Arcidiacono,

Bhutani

et al. 2024

Cancers

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In this 14th document in a series of papers entitled “Controversies in Endoscopic Ultrasound” we discuss various aspects of EUS-guided biliary drainage that are debated in the literature and in practice. Endoscopic retrograde cholangiography is still the reference technique for therapeutic biliary access, but EUS-guided techniques for biliary access and drainage have developed into safe and highly effective alternative options. However, EUS-guided biliary drainage techniques are technically demanding procedures for which few training models are currently available. Different access routes require modifications to the basic technique and specific instruments. In experienced hands, percutaneous transhepatic cholangiodrainage is also a good alternative. Therefore, in this paper, we compare arguments for different options of biliary drainage and different technical modifications.

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