Endoscopic ultrasound guided biliary and pancreatic duct interventions

Table 1 Summary of recently published reports of endoscopic ultrasound-guided biliary interventions including > 35 patients

Ref.	n	Access point	Stent placement			Successful drainage n (%)	Complications		Notes
			TP		TM		n (%)	Type
			RV	AG
Maranaki et al[46] 2009	49	IH EH	- -	26a 8	3 4	29/40 (73%) 12/14 (86%)	8/49 (16%)b	Pneumoperitoneum (4) Biliary peritonitis (1) Bleeding (1) Aspiration pneumonia (1) Abdominal pain (1)	Retrospective Five patients converted from IH to EH and have been included here to demonstrate success via access point (IH n = 40, EH n = 14) Overall technical success of drainage 41/49 patients (84%) aIncludes one antegrade placement of intra-ductal stent and 1 balloon dilation of stricture (i.e., the stricture was traversed by the guidewire) bComplication rate per patient (IH n = 5, EH n = 3)
Park et al[50] 2011	57	IH EH	- 2	- -	31 24	31/31 (100%) 26/26 (100%)	11/57 (19%)	Pneumoperitoneum (7) Biliary peritonitis (2) Bleeding (2)	Prospective follow up Primary procedural aim was transmural stenting. A rendezvous technique was successfully utilized in 2 patients with malignant disease in whom TM EH stenting was not possible All 6 patients with benign strictures had previously failed an EUS guided rendezvous procedure
Vila et al[52] 2012	106	NS	NS	NS	NS	73/106 (69%)	24/106 (23%)	NSc	Retrospective case series pooling biliary and pancreatic intervention: 19 hospitals, 23 endoscopists, 106 biliary and 19 pancreatic interventions cComplications were not specified by procedure type. Of the 29 complications among the biliary and pancreatic interventions 5 were managed endoscopically, 3 with percutaneous intervention and 2 were managed surgically
Shah et al[47] 2012	70	NS	39	19		58/76d,e (76%) Procedures 58/68d,e (85%) Patients	6/76d,e (8%) Procedures 6/70d,e (9%) Patients	Pancreatitis (2) Hematoma (1) Bile leak (1) Infection (1) Duodenal perforation (1)	Retrospective Complications include those from ERCP attempted prior to ESCP dIn 2 patients intervention was deemed unnecessary after cholangiography. Crossover between antegrade stenting and rendezvous procedure was allowed freely; 6 patients failed rendezvous and were treated successfully by an antegrade EUS intervention, 2 patients failed direct EUS guided therapy and successfully underwent a ESCP rendezvous procedure. Therefore 76 procedures were performed with therapeutic intent eSuccess and complication rates are described on a “per procedure” and “per-patient” basis as some patients had more than one procedure
Iwashita et al[41] 2012	40	IH EH	4 25	- -	- -	4/9 (44%) 25/31 (81%)	5/40 (13%)	Pancreatitis (2) Abdominal pain (1) Pneumoperitoneum (1) Fever, subsequent death (1)	Retrospective Only rendezvous procedures attempted. No transmural drainage or antegrade stenting Overall technical success in 29/40 patients (73%) Technical failure due to inability to pass guidewire to small intestine in 11 patients (27%)
Dhir et al[33] 2012	58	EH	57	-	-	57/58 (98%)	2/58 (3%)	Contrast leakage (2)	Retrospective Only rendezvous procedures attempted. No transmural drainage or antegrade stenting
Dhir et al[49] 2013	35	IH EH	16 18	- -	- -	16/17 (94%) 18/18 (100%)	12/35 (34%)	Pain (7) Bile leak (2) Pneumoperitoneum (2) Pain (1)	Retrospective Only rendezvous procedures attempted. No transmural drainage or antegrade stenting Overall technical success in 34/35 (97%) Failure due to inability to traverse obstruction with guidewire 11 (of 12 total) complications occurred in the TH cohort
Park et al[51] 2013	45	NS	NS	NS	NS	41/55f (75%) Procedures 41/45f (91%) Patients	5/55f (9%) Procedures 5/45f (11%) Patients	Pancreatitis (1) Biliary peritonitis (1) Pneumoperitoneum (1) Stent Migration (1) Biloma (1)	Prospective observational cohort study Mixture of rendezvous procedures, antegrade stent placement, transmural drainage or repeat attempt at ERCP. Significant crossover during procedures depending on clinical scenario; 10 patients underwent an alternate interventional strategy after the initial procedure failed fSuccess and complication rates are described on a “per procedure” and “per-patient” basis as some patients had more than one procedure
Khashab et al[53] 2013	35	IH EH	2 11	-	5g 15	33/35 (94%)	4/35 (12%)	Pancreatitis (1) Pneumoperitoneum (1) Retained sheared wire (1) Acute cholecystitis (1)	Retrospective An initial attempt using a rendezvous technique was followed by a transluminal approach if rendezvous failed gTwo patients had trans-esophageal stents placed
Gupta et al[80] 2014	240	IH EH	NS NS	NS NS	NS NS	132/145 (90%) 75/89 (84%)	81/238 (34%)	Bile leak (27) Bleeding (26) Pneumoperitoneum (12) Cholangitis (11) Abdominal pain (5) Stent occlusion (2)	Retrospective Data reported here as they are in the paper; internal consistencies in data reporting without explanation make this data difficult to interpret Overall technical success reported in 87% of patients 52 (of 146, 36%) complications in the IH group and 29 (of 89, 33%) in the EH group
Kawakubo et al[48] 2014	64	IH EH	- -	- -	19 42	19/20 (95%) 42/44 (95%)	12 (19%)	Bile leakage (5) Stent misplacement (3) Bleeding (2) Pneumoperitoneum (1) Cholangitis (1) Biloma (1) Perforation (1)	Retrospective Only Transmural procedures attempted Transpapillary stent placement had been performed prior to ESCP in 31 (48%) patients Two failures in EH group due to failure to dilate tract. One failure in IH group due to failure to access non-dilated bile duct Six complications were reported in each group. Two stents deployed intra-peritoneally during IH TM drainage. One plastic stent migrated and resulted in perforation
Dhir et al[54] 2014	68	IH EH	NS NS	NS NS	NS NS	34/36 (94%) 31/32 (97%)	17/68 (25%)	Cholangitis (5) Bile leak (4) Death (3) Perforation (2) Pneumoperitoneum (2) Bleeding (1)	Retrospective 20 patients underwent rendezvous procedures, 35 underwent direct EUS guided intervention (AG TP or TM). IH approach used in 34 procedures and EH approach in 31 procedures Overall technical success reported in 65/68 (87%) of patients

Superscripts refer to specific comments in the “Notes” column. AG: Antegrade; EH: Extrahepatic; ESCP: Endosonography guided cholangio-pancreatography; EUS: Endoscopic ultrasound; IH: Intrahepatic; NS: Not specified; RV: Rendezvous; TM: Transmural; TP: Transpapillary.

Table 2 Summary of recently published reports of endoscopic ultrasound-guided pancreatic interventions including > 9 patients

Pancreatic	Procedures (n)	MPD access	Stent placement		Success	Procedure related complications		Notes
			RV	TM	Per procedure, n (%) [per patient, n (%)]	n (%)	Type
Kinney et al[81] 2009	9	7/9 (78%)	4	-	4/9 (45%)	3/9 (33%)	Pancreatitis (1) Retroperitoneal and intraperitoneal air (1) Fever (1)	Retrospective All patients post Whipple procedure with endoscopic rendezvous attempted via the afferent limb Causes of failures: inability to access the MPD (2) and inability to traverse the pancreaticojejunal anastomosis with the guidewire (3) All patients with successful decompression had good short term clinical relief
Barklay et al[73]2010	21	18/21 (86%)	10a	-	10/21 (48%)	3/21 (14%)	Infection (1) Pancreatitis (1) Shaving of guidewire (1)	Retrospective Among 14 dilated MPDs and 7 normal calibre MPDs, the 3 failed pancreatograms occurred in patients with a normal calibre MPD Unable to pass wire to papilla in 8/12 patients: suboptimal angle (3), tight stricture (5) aFour patients successfully underwent rendezvous procedure, six patients successfully underwent repeat ERCP after methylene blue injection into MPD to aid identification of ampulla
Ergun et al[76] 2011	24 (20 pts)	20/20b (100%)	5	15	20/24 (83%) [18/20 (90%)]	2/24 (8%) [2/20 (10%)]	Bleeding (1) Perigastric collection (1)	Retrospective The reason for 24 procedures among 20 patients is unclear bSuccessful pancreatography reported in “all 20 patients”
Vila et al[52] 2012	19	NS	NS	NS	11/19 (60%)	5/19 (26%)	NSc	Retrospective case series pooling biliary and pancreatic intervention: 19 hospitals, 23 endoscopists, 106 biliary and 19 pancreatic interventions cComplication type per procedure is not specified. Of the 29 complications among the biliary and pancreatic interventions 5 were managed endoscopically, 3 with percutaneous intervention and 2 were managed surgically
Shah et al[47] 2012	30 (25 pts)	25/25d (100%)	9/16	10/14	19/30 (63%)e [19/22 (86%)d]	4/30 (13%)e	Pneumoperitoneum (1) Pancreatitis (3)	Retrospective dAfter pancreatography 3 patients were not felt to warrant intervention e30 therapeutic procedures were attempted (in 22 patients) due to significant crossover during intervention: 6 of 7 failed RV had attempted EUS guided antegrade therapy (5/6 successful); 2 of 3 failed antegrade EUS underwent attempted ERCP (double-balloon guided, 2/2 successful)
Kurahira et al[74] 2013	17 (14 pts)	17/17 (100%)	11	3 (4)f	15/17 (88%)	1/17 (6%)	Pssudocyst and aneurysm due to PD puncture (1)	Retrospective Two cases did not proceed after pancreatogram; complications during guidewire passage? f One patient had a temporary naso-pancreatic drain with subsequent stent insertions
Fujii et al[71] 2013	46 (43 pts)	45/46g (98%)	14	18	32/46g (70%) [32/43 (74%)]	16/46g (30%)	Abdominal Pain (13) Pancreatitis (1) Peri-panreatic abscess (1) Retained guidewire fragment (1)	Retrospective gFor successful stent placement, three additional procedures were required in two patients

Superscripts refer to specific comments in the “Notes” column. ERCP: Endoscopic retrograde cholangio-pancreatography; EUS: Endoscopic ultrasound; MPD: Main pancreatic duct; Pts: Patients; RV: Rendezvous; TM: Transmural.