EUS-guided biliary and pancreatic access and drainage (i.e. EUS-guided ERCP)

What is ERCP?

ERCP is a specialized endoscopic technique to evaluate the bile ducts, pancreas ducts and gallbladder. Ducts are drainage routes for various organs; the drainage channels from the liver are called bile or biliary ducts while the pancreatic duct is the drainage channel from the pancreas. Different diseases such as stones, pancreatitis, cancer, surgical injuries, can cause blockages or leaks of these ducts. ERCP is the gold standard to access these ducts to remove stones, open up blockages and even diagnosis cancers.

During ERCP flexible, lighted tube known as an endoscope is inserted into the mouth and down the throat. This goes down into the stomach and upper part of the small intestine (duodenum). In this area, an opening (ampulla) to the bile and pancreas ducts is found. At that time, the opening can be accessed with various tools, wires, and dye to study and treat the ducts of the liver and pancreas.

Is ERCP always successful?

At centers of excellence the success rates of ERCP are greater than 95%.  But even in expert hands there can be reasons that conventional ERCP cannot be possible.  These reasons include stomach/intestinal tumors blocking the endoscope from reaching the ampulla or altered intestinal anatomy.

What is EUS-guided ERCP?

For the rare cases when ERCP is not successful, patients are usually sent to an interventional radiologist for percutaneous drainage (a temporary catheter through the skin into the liver).   This form of therapy is successful but also painful for patients as they are left with a plastic tube hanging out of their skin for an indefinite period of time.  Various complications related to the catheter including infection, pain, blockage can also occur requiring patients to undergo multiple procedures.

Endoscopists can now access and drain the bile duct or pancreas duct completely internally via EUS when conventional ERCP is not possible.  By endosonography a direct puncture into the biliary system can be made from the stomach or duodenum through which wires and stents can be placed in a variety of fashions. This allows the therapy for these diseases to be performed completely from inside the body, without catheters through the skin, and on an outpatient basis.  Growing literature on this technique shows it to be safe, effective, and better tolerated by patients because it is less painful than percutaneous drainage.

EUS-guided ERCP in Dallas, Tx

Are you interested in learning more about EUS-guided ERCP, or other treatment options? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.

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