- Email: [email protected]
Sa1390 Loop-Tip Versus Straight-Tip Guidewire in Biliary Cannulation: A Prospective Randomized Trial
Abstracts
Background and Aim: Wire-guided cannulation (WGC) has been widely accepted as a useful technique in achieving selective biliary access because it has significantly increased the success rate of biliary cannulation compared with conventional contrast-assisted cannulation. The aim of this study was to compare the cannulation outcomes between a loop-tip guidewire (LGW) and a straight-tip guidewire (SGW) in patients with a naïve papilla. Methods: From May 2014 to December 2015, we performed 192 biliary cannulations for a naïve papilla in a randomized controlled trial. Patients were randomly assigned to the LGW group (nZ96) or the SGW group (nZ96). Crossover was not included in the study protocol. Results: There was no significant difference in primary successful biliary cannulation between the two groups (LGW group: 86.5%; SGW group: 77.1%; P Z 0.134). The rate and the mean number of unintentional pancreatic duct cannulations during WGC were significantly lower in the LGW group than in the SGW group (LGW group: 14.6%; SGW group; 28.1%; P Z 0.034; LGW group: 0.2 0.5; SGW group: 0.6 1.3; P Z 0.007). Post-ERCP pancreatitis developed in 5.2% of patients in the LGW group and 8.3% of patients in the SGW group (P Z 0.567). Conclusions: WGC with the LGW was equally effective and safe as with the SGW for selective biliary cannulation. Use of the LGW was associated with a lower rate of unintentional pancreatic duct cannulation during WGC in comparison with the SGW.
Sa1389 Ercp Placed Short Biliary Self-Expanding Metal Stents (SSEMS) and Neoadjuvant Therapy of Borderline Pancreatic Cancer in 100 Patients John Walker1, Tian Gao1, Andreas Stefan1, Daniil Rolshud1, David A. Klibansky1, Douglas A. Howell*1, Gina Z. Blaszyk2, Lisa A. Rutstein2 1 Advanced Interventional Endoscopy, Maine Medical Center, Portland, ME; 2Surgery, Maine Medical Center, Portland, ME Background: Neoadjuvant therapy (NeoRx) has been increasingly reported for preoperative treatment of pancreatic adenocarcinoma (PANCA). In the subgroup of jaundiced patients (pts) treated with plastic biliary stents, occlusions during NeoRx have led to recommending placing short self-expanding metal stents (SSEMS) before starting chemotherapy. We report a large single-center experience using non-foreshortening uncoated SSEMS. Methods: All pts with biopsy-proven PANCA causing obstructive jaundice, regardless of stage, undergo ERCP with SSEMS placement or prompt SSEMS replacement of plastic stents. Up-front surgery is recommended for early PANCA (Stage 1a) and palliative stenting with (chemoRx) chemotherapy for late stages (III & IV). NeoRx of 8 wks of Gemcitabine with 2 wks of XRT is offered to stented pts with locally-advanced or borderline resectable tumors. Pts are followed for evidence of stent dysfunction, impact on completion of NeoRx, progression of disease, interference with surgery, and final resection stage. Data are entered into an IRBapproved database. Patients: 100 consecutive stented pts (age 36-87, median 68) accepted NeoRx. Stages were IBZ27, IIAZ42, IIBZ31. After 8 wks of NeoRx and a 4 wk rest, restaging was followed by surgery, if appropriate. Results: 100 pts underwent ERCP with 10x40 or 10x60 SSEMS placement with one complication of post-EUS hemobilia with transient SSEMS occlusion, which cleared before NeoRx. During 8 wks of chemotherapy, 5/100 (5%) developed stent dysfunction (recurrent jaundice 3, cholangitis 2) but only 2 missed any chemoRx (< 5% of total doses). During the rest period 7/89 (7.9%) developed occlusion (jaundice 4, cholangitis 3) treated with ERCP. One case had stone-related cholecystitis and one had tumor bleeding needing embolization. The role of the SSEMS was unclear in these two cases. 9/100 (9%) did not complete NeoRx (comorbidity or progression 4, toxicity 3, dropout 2). At restaging, 22/91 (24%) revealed metastatic disease (nZ20) and/or progression with vascular encasement (nZ3). 69/91 (75.8%) cases underwent attempted Whipple resection and 13/69 (18.8%) proved to be unresectable due to mets or vascular encasement. Resections were successfully performed in 56/69 (81.2%) of restaged cases or 56/100 (56%) of the total study group. Resections were R0Z48, R1Z8, R2Z0. No interference with the line of resection or other surgical complications due to the presence of the SSEMS was noted. Conclusion: In this large series, ERCP placement of non-foreshortening uncoated SSEMS permitted NeoRx in all cases without interfering with NeoRx protocol or surgery. This approach allows pts with occult stage III/ IV or biologically-aggressive cancers to avoid surgery. Reliable SSEMS placement below the line of resection, absence of migration, and avoidance of other early complications appear to be advantages of this approach.
Sa1390 Loop-Tip Versus Straight-Tip Guidewire in Biliary Cannulation: A Prospective Randomized Trial Jae Chul Hwang*, Byung Moo Yoo, Min Jae Yang, YeonKyung Lee, Ju Young Lee, Kihyun Lim, Choong Kyun Noh, Hyo Jung Cho, Soon Sun Kim, Jin Hong Kim Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea (the Republic of)
www.giejournal.org
Figure 1 Guidewires. (a) A loop-tip guidewire. (b) A straight-tip guidewire.
Figure 2 Wire-guided cannulation with the loop-tip guidewire. After a minimal advance (2 mm) of the guidewire tip outside the sphincterotome and a minimal insertion of the sphincterotome across the papilla, the guidewire was advanced into the bile duct under fluoroscopy to achieve deep biliary cannulation. (a) Endoscopic view. (b) Radiologic image.
Sa1391 Endoscopic Pancreatic Sphincterotomy Combined With Pancreatic Duct Stent Can Effectively Prevent Recurrence of Acute Recurrent Pancreatitis Caused by Biliary Microlithiasis — A Single-Center Study From Beijing, China YongHui Huang*, Hong Chang, WenZheng Liu, YaoPeng Zhang, Wei Yao, Ke Li, Xiu E. Yan Peking University Third Hospital, Beijing, —选择—, China
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB221
Background and Aim: Wire-guided cannulation (WGC) has been widely accepted as a useful technique in achieving selective biliary access because it has significantly increased the success rate of biliary cannulation compared with conventional contrast-assisted cannulation. The aim of this study was to compare the cannulation outcomes between a loop-tip guidewire (LGW) and a straight-tip guidewire (SGW) in patients with a naïve papilla. Methods: From May 2014 to December 2015, we performed 192 biliary cannulations for a naïve papilla in a randomized controlled trial. Patients were randomly assigned to the LGW group (nZ96) or the SGW group (nZ96). Crossover was not included in the study protocol. Results: There was no significant difference in primary successful biliary cannulation between the two groups (LGW group: 86.5%; SGW group: 77.1%; P Z 0.134). The rate and the mean number of unintentional pancreatic duct cannulations during WGC were significantly lower in the LGW group than in the SGW group (LGW group: 14.6%; SGW group; 28.1%; P Z 0.034; LGW group: 0.2 0.5; SGW group: 0.6 1.3; P Z 0.007). Post-ERCP pancreatitis developed in 5.2% of patients in the LGW group and 8.3% of patients in the SGW group (P Z 0.567). Conclusions: WGC with the LGW was equally effective and safe as with the SGW for selective biliary cannulation. Use of the LGW was associated with a lower rate of unintentional pancreatic duct cannulation during WGC in comparison with the SGW.
Sa1389 Ercp Placed Short Biliary Self-Expanding Metal Stents (SSEMS) and Neoadjuvant Therapy of Borderline Pancreatic Cancer in 100 Patients John Walker1, Tian Gao1, Andreas Stefan1, Daniil Rolshud1, David A. Klibansky1, Douglas A. Howell*1, Gina Z. Blaszyk2, Lisa A. Rutstein2 1 Advanced Interventional Endoscopy, Maine Medical Center, Portland, ME; 2Surgery, Maine Medical Center, Portland, ME Background: Neoadjuvant therapy (NeoRx) has been increasingly reported for preoperative treatment of pancreatic adenocarcinoma (PANCA). In the subgroup of jaundiced patients (pts) treated with plastic biliary stents, occlusions during NeoRx have led to recommending placing short self-expanding metal stents (SSEMS) before starting chemotherapy. We report a large single-center experience using non-foreshortening uncoated SSEMS. Methods: All pts with biopsy-proven PANCA causing obstructive jaundice, regardless of stage, undergo ERCP with SSEMS placement or prompt SSEMS replacement of plastic stents. Up-front surgery is recommended for early PANCA (Stage 1a) and palliative stenting with (chemoRx) chemotherapy for late stages (III & IV). NeoRx of 8 wks of Gemcitabine with 2 wks of XRT is offered to stented pts with locally-advanced or borderline resectable tumors. Pts are followed for evidence of stent dysfunction, impact on completion of NeoRx, progression of disease, interference with surgery, and final resection stage. Data are entered into an IRBapproved database. Patients: 100 consecutive stented pts (age 36-87, median 68) accepted NeoRx. Stages were IBZ27, IIAZ42, IIBZ31. After 8 wks of NeoRx and a 4 wk rest, restaging was followed by surgery, if appropriate. Results: 100 pts underwent ERCP with 10x40 or 10x60 SSEMS placement with one complication of post-EUS hemobilia with transient SSEMS occlusion, which cleared before NeoRx. During 8 wks of chemotherapy, 5/100 (5%) developed stent dysfunction (recurrent jaundice 3, cholangitis 2) but only 2 missed any chemoRx (< 5% of total doses). During the rest period 7/89 (7.9%) developed occlusion (jaundice 4, cholangitis 3) treated with ERCP. One case had stone-related cholecystitis and one had tumor bleeding needing embolization. The role of the SSEMS was unclear in these two cases. 9/100 (9%) did not complete NeoRx (comorbidity or progression 4, toxicity 3, dropout 2). At restaging, 22/91 (24%) revealed metastatic disease (nZ20) and/or progression with vascular encasement (nZ3). 69/91 (75.8%) cases underwent attempted Whipple resection and 13/69 (18.8%) proved to be unresectable due to mets or vascular encasement. Resections were successfully performed in 56/69 (81.2%) of restaged cases or 56/100 (56%) of the total study group. Resections were R0Z48, R1Z8, R2Z0. No interference with the line of resection or other surgical complications due to the presence of the SSEMS was noted. Conclusion: In this large series, ERCP placement of non-foreshortening uncoated SSEMS permitted NeoRx in all cases without interfering with NeoRx protocol or surgery. This approach allows pts with occult stage III/ IV or biologically-aggressive cancers to avoid surgery. Reliable SSEMS placement below the line of resection, absence of migration, and avoidance of other early complications appear to be advantages of this approach.
Sa1390 Loop-Tip Versus Straight-Tip Guidewire in Biliary Cannulation: A Prospective Randomized Trial Jae Chul Hwang*, Byung Moo Yoo, Min Jae Yang, YeonKyung Lee, Ju Young Lee, Kihyun Lim, Choong Kyun Noh, Hyo Jung Cho, Soon Sun Kim, Jin Hong Kim Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea (the Republic of)
www.giejournal.org
Figure 1 Guidewires. (a) A loop-tip guidewire. (b) A straight-tip guidewire.
Figure 2 Wire-guided cannulation with the loop-tip guidewire. After a minimal advance (2 mm) of the guidewire tip outside the sphincterotome and a minimal insertion of the sphincterotome across the papilla, the guidewire was advanced into the bile duct under fluoroscopy to achieve deep biliary cannulation. (a) Endoscopic view. (b) Radiologic image.
Sa1391 Endoscopic Pancreatic Sphincterotomy Combined With Pancreatic Duct Stent Can Effectively Prevent Recurrence of Acute Recurrent Pancreatitis Caused by Biliary Microlithiasis — A Single-Center Study From Beijing, China YongHui Huang*, Hong Chang, WenZheng Liu, YaoPeng Zhang, Wei Yao, Ke Li, Xiu E. Yan Peking University Third Hospital, Beijing, —选择—, China
Volume 85, No. 5S : 2017 GASTROINTESTINAL ENDOSCOPY AB221