Endoscopic Retrograde Cholangiopancreatography

Abstract

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) is still the subject of intensive clinical research. This year, new data were presented during the Digestive Disease Week (DDW) on biliary stenting, as well as ERCP-associated complications and methods of prevention. In addition, several abstracts discussed the use of combined ERCP and endoscopic ultrasonography (EUS) techniques for diagnostic and therapeutic management in biliary and pancreatic diseases. This review highlights the most relevant studies, which will be reported in detail. The remaining abstracts are cited as references, and in some cases summarized in the tables. Benign Biliary DiseaseRemoval of common bile duct (CBD) stones can be achieved following either biliary sphincterotomy or endoscopic papillary balloon dilation (EPBD). A meta-analysis by Baron and Harewood summarized eight randomized controlled trials (including a total of 1106 patients), comparing the two techniques for CBD stone removal with regard to success rates and complication rates [1]. EPBD and biliary sphincterotomy resulted in similar outcomes with regard to overall successful stone removal (94.3 % vs. 96.5 %) and overall complications (10.5 % vs. 10.3 %). However, bleeding occurred less frequently with EPBD (0 % vs. 2 %; P = 0.001), whereas post-ERCP pancreatitis occurred more commonly in the EPBD group (7.4 % vs. 4.3 %; P = 0.05). Patients undergoing EPBD were also more likely to require mechanical lithotripsy for stone extraction (20.9 % vs. 14.8 %; P = 0.014). On the basis of these results, EPBD should be the strategy of choice over biliary sphincterotomy for endoscopic removal of CBD stones in patients with coagulopathy, although it cannot be routinely recommended. A second meta-analysis by Weinberg et al., summarizing 13 randomized controlled trials, confirmed these results [2]. Finally, a study compared EPBD vs. biliary sphincterotomy for CBD stones in liver cirrhosis patients with coagulopathy, showing a lower rate of bleeding and no significant difference with regard to post-ERCP pancreatitis [3].An interesting retrospective study by Costamagna's group assessed the role of extracorporeal shock-wave lithotripsy (ESWL) associated with ERCP in the endoscopic management of intrahepatic lithiasis in 129 patients [4]. Of 215 patients presenting with intrahepatic lithiasis, 76 underwent ERCP with stone extraction, and the remaining 129 had combined ERCP and ESWL. Combined therapy with ESWL appeared to be more successful for complete stone removal (53.9 % vs. 75.9 %; P < 0.05).Endoscopic biliary stenting is the optimal nonsurgical therapy for biliary leaks resulting from trauma or occurring postoperatively. Escalante-Glorsky and colleagues investigated endoscopic therapy in extrahepatic (n = 206) and intrahepatic biliary leakage (n = 27) [5]. Treatment included biliary sphincterotomy and placement of a 7 ± 10-Fr straight polyethylene stent to bypass the site of leakage, or within the leaking intrahepatic duct. Success rates relative to healing were 94 % for extr...

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