Endoscopic ultrasound-guided drainage effective after failed ERCP

Last Updated: 2016-08-26

By Will Boggs MD

NEW YORK (Reuters Health) - Endoscopic ultrasound (EUS)-guided pancreatic drainage is effective for pancreatic strictures after failed ERCP, according to results from an international study.

"The success rate was really impressive," Dr. Michel Kahaleh from Weill Cornell Medical College, New York told Reuters Health by email. "Therapeutic EUS for pancreatic duct drainage can really constitute an alternative to surgery."

Endoscopic retrograde pancreatography (ERCP) is first-line therapy for the management of pancreatic duct obstruction and pain from chronic pancreatitis, whereas surgical intervention has been the conventional approach when ERCP could not be performed.

Dr. Kahaleh and colleagues from the U.S., Brazil, and France investigated the safety and efficacy of EUS-guided pancreatic drainage in their study of 80 patients who had failed conventional endoscopic therapy.

They achieved technical success (successful drainage with stent placement) in 71 patients (89%), as reported July 23rd online in Gastrointestinal Endoscopy.

More than 80% (65/80) of patients overall and 92% (65/71) of patients who achieved technical success had clinical success (relief of symptoms), and only one patient ultimately required surgical intervention.

Clinical results tended to be better during a median 15 months' follow-up among patients who had retrograde stent placement (versus those who had anterograde stent placement).

One in five patients had immediate adverse events, four of which were mild and 12 of which were major. Nine patients had delayed adverse events; all of these patients also had immediate adverse events.

"In a very frustrating disease where options are limited, EUS-guided drainage of the pancreatic duct offers a minimally invasive and safe solution," Dr. Kahaleh said. "Therapeutic EUS is slowly replacing complex surgeries as illustrated in this paper."

SOURCE: http://bit.ly/2c2fL81

Gastrointest Endosc 2016.