In Focus

The Light at the End of the Tunnel: Recent Advances in Endoscopic Retrograde Cholangiopancreatograpy

Publish date: September 1, 2017

 

Risks and complications

Figure 5: Intraductal EHL: The EHL probe is located near the stone and the lithotripsy is performed. The bilary duct needs to be immersed with water to increase electric wave delivery and to protect the duct wall from injury.

In general, complications from cholangioscopy systems are similar to traditional ERCP. These complications can range from relatively mild to potentially life-threatening sequelae including: cholangitis, bacteremia, abdominal pain, pancreatitis, hypotension, nausea, liver abscesses, radiculopathy, bile duct drilling (from the guide-wire), clinically insignificant amylase and lipase elevation, and systemic inflammatory response syndrome.24 A large retrospective study evaluated whether ERCP with cholangiopancreatoscopy was associated with higher rates of complication than ERCP alone. A total of 4,214 ERCPs were included, of which 402 ERCPs with cholangiopancreatoscopy were analyzed. Adverse event rates for the ERCP alone group and ERCP with cholangiopancreatoscopy were 2.9% and 7.0%, respectively, with an odds ratio of 2.5. This study revealed a significantly higher rate of cholangitis, which the authors proposed was due to the saline irrigation needed for visualization during the procedure.28 Duodenal perforation appears to be rare and was treated conservatively.14,29

Conclusions

Direct visualization of the biliary and pancreatic ductal system with fiber-optic and now digital-based platforms have greatly expanded the diagnostic and therapeutic capabilities available to gastroenterologists in the diagnosis and management of biliary and pancreatic disorders. The digital single-operator cholangiopancreatascope system offers greater diagnostic yield of pancreaticobiliary disorders over conventional diagnostic sampling techniques. In addition, direct visualization has expanded our therapeutic ability in complex stone disease allowing laser-based therapies that are not available with traditional fluoroscopic based techniques. Cholangiopancreatoscopic techniques and indications are rapidly expanding and will continue to expand the diagnostic and therapeutic armamentarium available to gastroenterologists.

Dr. Sonnier is a general gastroenterology fellow, division of gastroenterology, University of South Alabama. Dr. Mizrahi is director of advanced endoscopy, division of gastroenterology, University of South Alabama. Dr. Pleskow, is clinical chief, department of gastroenterology, Beth Israel Deaconess Medical Center, and associate professor of medicine, Harvard Medical School, Boston. Dr. Sonnier and Dr. Mizrahi have no conflicts of interest. Dr. Pleskow serves as a consultant to Boston Scientific.

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Pages

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