Diagnostic value of endoscopic retrograde cholangiopancreatography and therapeutic value of endoscopic sphincterotomy in dogs with suspected hepatobiliary disorders

Abstract

Background Conventional diagnostic methods have some limitations in diagnosing specific causes of canine hepatobiliary disorders. In the evaluation of the hepatobiliary system in dogs, ultrasonography (US) is the first imaging method of choice. Nonetheless, endoscopic retrograde cholangiopancreatography (ERCP) has also been proven to be a practicable technique for evaluating canine hepatobiliary (endoscopic retrograde cholangiography, ERC) and pancreatic duct (endoscopic retrograde pancreatography, ERP) disorders, providing additional therapeutic options by sphincterotomy (EST). To date, the efficacy and safety of diagnostic and therapeutic ERCP has not been evaluated in veterinary medicine literature. The present study sought to report complications and outcomes of dogs undergoing ERCP and EST, and to assess the usefulness of diagnostic ERCP by comparing the findings of US, ERCP and histopathological findings in liver and pancreas. Results This retrospective case series comprises data collected from 15 dogs that underwent successful ERC/ERCP. Nine dogs underwent EST following ERC. US and ERC were best in agreement when assessing the common bile duct. In case of disagreement between the modalities, the ERC findings of the ductal structures were in line with the available pathology findings more often than the US findings, whereas the opposite was noted for the gallbladder. The technical success rates were 88.2% for ERC, 66.7% for ERP, and 81.8% for EST, with no major complications during or immediately after the procedure. Immediate bile flow after EST was recorded in 7/9 dogs but only four showed coinciding clinical and laboratory improvement and four dogs were euthanized within 1-6 days after EST. Conclusions US remains a valuable initial diagnostic imaging method for hepatobiliary disorders and allows good assessment of the gallbladder. ERC can serve as a complementary procedure for diagnostic assessment of the hepatobiliary duct disorders. However, in order to improve the outcomes of EST, careful selection of patients for the procedure would require more advanced diagnostic imaging of the hepatobiliary area.

Feasibility of Magnetic Resonance Cholangiopancreatography in Dogs—A Post-Mortem Study

“…In a study of 45 dogs with cholangitis confirmed by histopathology, ultrasonography showed a distended GB in 24 dogs (53.3%) [1]. In a retrospective study, ultrasonography revealed distended GB in three of seven dogs with various types of cholangitis; one out of those three dogs had concurrent biliary stasis [17].…”

“…Previous studies have shown that ERCP is technically demanding in live dogs, with a success rate between 66% and 87%. The risk of complications seems to be low but should be considered when planning ERCP in canine patients [16,17]. MRCP is a less invasive alternative to diagnostic ERCP and may be a beneficial imaging tool to distinguish patients that require therapeutic ERCP from those requiring abdominal surgery or medical intervention.…”

“…ERCP applies a combination of endoscopy and fluoroscopy to image the biliary tree and pancreatic ducts. Few studies in veterinary medicine have been performed using this technique in normal dogs [16] and in dogs with gastrointestinal diseases [17][18][19]. The diameter of the CBD has been measured by ERCP in both healthy and diseased dogs [16,17,19].…”