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e140
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
with PAD, 6 controls were randomly selected for statistical analysis.
The presence of a PAD was diagnosed either endoscopically or by its
characteristic EUS appearance after instilling 100-200 ml of water to
fill and extend the duodenal lumen.
Results:
2475 patients met the inclusion criteria. Among them
185 subjects with PAD were found (prevalence 7.5%), 1110 subjects
served as controls. Patients with PAD were older than controls
(mean age 69.8 ± 11.3 vs 61.4 ± 13.86 years; p<0.0001), had a higher
prevalence of common bile duct (CBD) dilation (44.3 vs 28.2%; OR
2.03 p<0.0001], a higher prevalence of CBD stones (34 vs 19.6%;
OR 2.11, p<0.0001) and a higher prevalence of cholangitis in their
clinical history (8.1 vs 2.2%; OR 3.99, p<0.0001). No differences
between PAD patients and controls were found as far as gender,
history of jaundice, of acute/recurrent pancreatitis or EUS signs of
chronic pancreatitis are concerned.
Conclusions:
To our knowledge, this is the first study that has
assessed PAD prevalence using EUS. We demonstrated that PAD can
be seen either endoscopically (at least using an oblique viewing
echoendoscope) or endosonographically and found a prevalence
that is in keeping with the existent literature. As other Authors in
an ERCP setting, we demonstrated a link between PAD and biliary
disease. Despite some anecdotal reports, we could not confirm a link
between PAD and pancreatic disease.
P.03.3
USEFULNESS OF ENDOSCOPIC ULTRASONOGRAPHY TO GUIDE
THE RATIONAL USE OF ERCP: STRATIFY THE LIKELIHOOD
OF CHOLEDOCHOLITHIASIS IN THE CLINICAL SUSPICION OF
PERSISTENT BILE DUCT STONE
Di Mitri R.*, Pecoraro G.M., Mocciaro F.
Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-
Benfratelli Hospital, Palermo, Italy
Background and aim:
Bile duct stones are a common clinical
problem and endoscopic retrograde cholangiopancreatography
(ERCP) is highly effective in relieving biliary obstruction despite
can carries adverse events related to the procedure or the sedation.
Endoscopic ultrasonography (EUS) is a very sensitive and specific
technique for diagnosing biliary diseases and represents lower-risk
alternative to confirm or exclude choledocholithiasis.
The aim of the study is to evaluate the role of EUS in predicting
choledocholithiasis, stratifing patients with clinical suspicion of
persistent bile duct stone who would benefit from ERCP.
Material and methods:
We collected data on all consecutive
patients from November 2014 to January 2015 suspected for
choledocholithiasis according toASGE criteria for choledocholithiasis
on initial presentation: intermediate risk (a serum bilirubin of 1,8 to
4 mg/dl or dilated common bile duct on ultrasound and/or abnormal
liver biochemical test other than bilirubin, age older than 55 years,
clinical gallstone pancreatitis) and high-probability (image of stone
inside the common duct, acute cholangitis and serum bilirubin
greater then 4 mg/dl and/or a serum bilirubin of 1,8 to 4 mg/dl or
dilated common bile duct on ultrasound). Then we re-classified
subjects’ risk of choledocholithiasis according to new biochemistry
in order to perform (or not) EUS.
Results:
We enrolled 51 patients (male [53%], mean age of
63±15 year): 14 (27%) and 37 (73%) patients were respectively at
intermediate and high risk. All patients were re-classified after a
median of 7 days (4-8). Patients at intermediate risk underwent:
EUS (5/14 [36%]), cholangio-RM or CT-scan (7/14, [50%]) and ERCP
due to increased risk (2/14, [14%]); for those evaluated with EUS in
2/5 (40%) ERCP was not performed due to absence of stones. Patients
at high risk: 8/37 (22%) underwent ERCP (due to persistence of high
risk), 7/37 (19%) underwent CT-scan and 22/37 (59%) underwent
EUS. In those evaluated with CT-scan 4 underwent EUS also as third
test due to mild reduction of bilirubin levels in absence of stones
at imaging (EUS was “positive” in all 4 patients who underwent
ERCP with stones removal). In the 22 patients evaluated with EUS as
second instrumental test (due to decrease of bilirubin levels), 9/22
(41%) did not underwent ERCP because of not evidence of stones
(these patients were discharged after 4-7 days asymptomatic and
with normal values of bilirubin); 13/22 (59%) resulted “positive”
for stones at EUS and underwent ERCP. Finally considering patients
reclassified with EUS (second or third test) we “saved” 9 (41%) of
ERCP in those classified as “high risk” at admittance.
Conclusions:
Our experience shows as EUS, according to assessment
of laboratory values, can help to improve the risk stratification
of those with suspicion of persistent bile duct stone eliminating
unnecessary diagnostic ERCP especially in patients classified as
“high risk” at admittance.
P.03.4
ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE FOR
MALIGNANT BILIARY OBSTRUCTION AFTER FAILED ERCP: A
SINGLE ITALIAN CENTER EXPERIENCE
Cecinato P.*, Zecchini R., Azzolini F., Decembrino F., Iori V., Sereni G.,
Tioli C., Cavina M., Parmeggiani F., Camellini L., Sassatelli R.
Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
Background and aim:
Endoscopic ultrasonography-guided biliary
drainage (EGBD) has been proposed as an alternative drainage
technique for percutaneous transhepatic biliary drainage (PTBD)
in patients with obstructive jaundice where endoscopic retrograde
cholangiopancreatography (ERCP) has failed.
Material and methods:
All patients afferent to Santa Maria Nuova
Hospital in Reggio Emilia, between January 2011 and December 2014,
with malignant obstructive jaundice, in whom ERCP had failed, were
enrolled. Inclusion criteria are: patients over 18 years old, malignant
bile duct obstruction with unsuccessful ERCP drainage. Patients
with benign stricture were excluded.
The end points were to evaluate technical and clinical success rate,
adverse events rate and follow-up of direct transluminal EGBD.
Technical success was defined as success of stent placement in the
desired location. Early clinical success was defined as a drop in the
bilirubin level by 50% at 2 weeks and late clinical success as a drop
to below 3 (level that allows patients to undergo chemotherapy) at
4 weeks.
Results:
During the study period, 23 patients (8 men; median age
69; interquartile range, 61 to 76) underwent EGBD. Reason for
EGBD was obscured ampulla by invasive cancer in 39.1% (9/23),
postsurgical anatomy in 30.4% (7/23), failed deep biliary cannulation
in 21.7% (5/23), hepaticojejunostomy stricture in 4.4% (1/23) gastric
outlet obstruction 4.4% (1/23).
EUS-guided cholangiography was successful and confirmed a distal
common bile duct stricture in 20 patients (87.0%). Technical success
in EGBD was achieved in 95.0% (19/20) of patient with a successful
cholangiography. Early clinical success was reached in 75.0% (15/20)
and late clinical success in 45.0% (9/20).
One (5%) procedure-related severe adverse event occurred in
1 patient. It was a severe cholangitis in a patient with several
comorbidities that died after 9 days after the procedure for
multiorgan failure.
Conclusions:
EGBD is a safe and effective procedure to provide
biliary access and drainage after failed ERCP. EGBD provides a viable
alternative to PTBD, and limited available data suggest equivalent
efficacy and safety.