Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound: To Be One Traveler in Converging Roads

Abstract

Background: Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) were initially introduced into the world of gastroenterology as purely diagnostic procedures. With progressive evolution of intervention, both these techniques conquered fields in the treatment of many conditions that had once been exclusively surgical domains. Nowadays, more and more clinical situations have an indication to perform both EUS and ERCP, and these two techniques are frequently required at the same time for the same patient. More than competitors, ERCP and EUS are truly complementary, with great ability for mutual aid. They share their main indications, equipment, accessories, and main technical gestures. Objectives and Methods: We review the major indications to perform both techniques, sequentially or complementarily, describe the common things that these two techniques essentially share, and discuss the ERCP-EUS single session. Also, the issues of learning curves and education of upcoming biliopancreatic endoscopists are highlighted. Conclusion: In recent years the complementation between ECRP and EUS has been growing both from a diagnostic and a therapeutic point of view, allowing optimization of the use of these techniques and the creation of a more systematized approach of patients with biliopancreatic pathology. Endoscopists with experience in both techniques will be increasingly important, suggesting a parallel formation in the training plans of future endoscopists with interest in the area.

“Lever Technique”: A Novel Approach to Cope with Unstable Scope Position during Bottom-up Needle Knife Access (with Video)

“… 1 Given the highly dynamic nature of bile duct stones with a high propensity for spontaneous passage, same-session EUS-ERCP provides a unique real-time stratification of individual patients for invasive ERCP. 2 Unless either duct is accessed during cannulation attempts, freehand needle knife papillotomy or fistulotomy remains the preferred rescue technique in day-to-day ERCP practice, however, with a low level of procedural standardization. Notwithstanding, EUS-guided individualized variations in needle knife techniques tailored to the specific anatomy present are achievable and may aid in procedural completion in otherwise challenging settings.…”

Diagnostic Accuracy of Endoscopic Ultrasonography Versus the Gold Standard Endoscopic Retrograde Cholangiopancreatography in Detecting Common Bile Duct Stones

“…A study regulated by Petrov et al demonstrates EUS lowering the risk of complications by a relative risk of 0.35, whereas avoiding ERCP in 67.1% of patients in their study with an initial EUS evaluation, thereby further reducing the risk of complication by an invasive procedure [ 22 ]. In a similar accord, many studies have persuaded the successful use of EUS and ERCP in a single session whenever both procedures are simultaneously indicated in a patient with more than a thousand cases are reported, although not yet common in routine care [ 23 ]. One study compared the use of EUS alone versus a combination of EUS and ERCP and concluded that the use of EUS before ERCP showed a significant reduction of procedure time and higher rates of successful procedures [ 24 ].…”

Clinical analysis of treatment strategies to cholecystocholedocholithiasis patients with previous subtotal or total gastrectomy: a retrospective cohort study

“…Historically, the treatment of CCL required open laparotomy and CBDE [ 14 ]. After the introduction of ERCP and endoscopic sphincterotomy in the 1970s, ERCP+LC provided a less invasive option for treating CCL and has largely replaced CBDE in the management of CCL in the last two decades [ 15 , 16 ]. With the development of laparoscopic equipment and technology, LCBDE has been widely used in clinical practice since its first introduction in 1991 [ 17 – 19 ].…”