Does same session EUS-guided tissue acquisition and ERCP increase the risk of pancreatitis in patients with malignant distal biliary obstruction?

HPB, vol. 24, pp. 1634–1641

Abstract

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography-guided tissue acquisition (EUS-TA) are increasingly performed in the same session in patients with malignant biliary obstruction. In this retrospective analysis, we investigated adverse events (AE) after same session ERCP and EUS-TA. METHODS: Patients with malignant distal biliary obstruction who underwent EUS-TA and/or ERCP with self-expandable metal stent (SEMS) placement from January 2015 to April 2020 were included. Primary outcome was post-procedural pancreatitis (PPP). Secondary outcomes were other procedure-related AE. RESULTS: We included 494 patients, of which 118 patients (24%) underwent same session EUS-TA+ERCP, 51 patients (10%) underwent separate session EUS-TA & ERCP, 90 patients (18%) ERCP-only and 235 patients (48%) EUS-TA only. PPP occurred in 22 patients (19%) after same session EUS-TA+ERCP and in 6 patients (12%) after separate EUS-TA & ERCP (p = 0.270). When adjusted for other known risk factors (i.e., difficult procedure), the difference in PPP remained non-significant (adjusted odds ratio 1.74 (95%-CI 0.65-4.67, p = 0.268). The incidence of other AE was similar, although the overall AE rate was significantly higher after same session EUS-TA+ERCP (36% vs. 20%, p = 0.030). CONCLUSION: Same session EUS-TA+ERCP did not significantly increase the incidence of PPP, although overall AE were significantly higher. These data warrant further prospective studies.

Authors 9

1. Myrte Gorris

   Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Cancer Center Amsterdam, the Netherlands

2. Noortje P. van der Valk

   Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

3. Paul Fockens

   Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Cancer Center Amsterdam, the Netherlands

4. Maarten Jacobs

   Cancer Center Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands

   Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Cancer Center Amsterdam, the Netherlands

5. Nahid S.M. Montazeri

   Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Amsterdam UMC, Location University of Amsterdam, Biostatistical Unit, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

6. Rogier P. Voermans

   Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Cancer Center Amsterdam, the Netherlands

7. Mattheus C.B. Wielenga

   Amsterdam UMC Location University of Amsterdam · Cancer Center Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism

   Affiliation as printed

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands

   Amsterdam UMC, Location University of Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Cancer Center Amsterdam, the Netherlands

8. Jeanin Elise van Hooft Aachen Department of Gastroenterology and Hepatology

   Leiden University Medical Center

   Affiliation as printed

   Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands

9. Roy L.J. van Wanrooij corresponding

   Cancer Center Amsterdam · Amsterdam Gastroenterology Endocrinology Metabolism · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands. Electronic address: rl.vanwanrooij@amsterdamumc.nl

   Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands

   Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Gastroenterology and Hepatology, Amsterdam, the Netherlands

   Cancer Center Amsterdam, the Netherlands