PWE-063 Single session EUS-ERCP; an effective approach. (June 2019) - Kamran, Umair
Abstract : Introduction: The primary objective of this study was to look at the safety and efficacy of single session endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) procedures at a tertiary care hospital. Methods: We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database from October 2017 to January 2019. Descriptive statistics were performed on Microsoft excel. We evaluated the reasons for the planned combined procedures, procedural characteristics and outcomes. Results: 55 patients were included in this study. Majority were females (35 vs 20) and median age was 69 years. 58% of patients (32) were referred for ERCP only but requests were reviewed by the consultant with expertise in performing both procedures and vetted for combined procedures instead. Most common reason for booking patients on combined slot was inability to identify cause of biliary obstruction (58%) on prior imaging followed by small (<5 mm) non-obstructing stone in asymptomatic patients (15%) and fine needle aspiration/biliary drainage (15%). 25 (45%) patients did not require ERCP as no pathology was identified on EUS. Average total time required for the combined procedure was 30 minutes (range: 20–50 minutes). Two patients had propofol and the median dose of fentanyl and midazolam used in the remaining patients were 100 mcg (50–200 mcg) and 4 mg (2–5 mg) respectively. One serious complication of ERCP was experienced. Although the patients who were symptomatic on the day of the procedure were more likely to require ERCP following EUS as compared to asymptomatic patients (78% vs 22%), but this difference was not found to be statistically significant. Conclusion: Performing EUS and ERCP in single sessions is a safe and effective strategy. Careful selection of patients for single session EUS-ERCP can avoid unnecessary high risk ERCP procedures. Patients who had planned combined procedure for suspected stone disease did not require significant extra time as compared to ERCP alone. We suggest that all ERCP requests should be reviewed by experienced endoscopists and prior EUS should be considered in selected patients.