Outcomes of minor versus major papilla rendez-vous for EUS-guided pancreatic duct drainage.

OBJECTIVES: EUS-guided pancreatic duct drainage (EUS-PD) using rendez-vous has been suggested as a safer alternative to pancreatogastrostomy. Fibrostenotic disease in the pancreatic head may however preclude major papilla rendez-vous, leading to preferential guidewire advancement through the minor papilla. Our aim was to compare the outcomes of minor and major papilla rendez-vous. METHODS: This is a tertiary single-center retrospective analysis of all consecutive EUS-PD procedures performed from 2015 to April 2022. EUS-PD was only performed following failed retrograde attempts. Successful EUS-PD rendez-vous cases were included and minor and major papilla procedures were compared. RESULTS: Thirty-three patients were included in the final analysis (66.6% male, mean age 56.1 [SD±14.8] years, 54.6% active smokers). In 21 patients (63.6%), minor papilla rendez-vous was attained. Clinical success was achieved in 81.0% vs. 58.3% in the major papilla group (p = 0.230). The overall incidence of AE was similar in both groups (9 [42.9%] vs. 4 [33.3%] events, p = 0.719), with a comparable distribution in severe, moderate and mild AE. Incidence of recurrent pancreatitis was almost identical (28.6% vs. 25.0%, p = 1.000). CONCLUSIONS: For patients with symptomatic chronic pancreatitis, EUS-PD using minor or major papilla rendez-vous attained similar results, suggesting that pancreatic duct drainage through the minor papilla can be considered as equally effective.

Performance and applicability of a first generation single-use duodenoscope: a single-center cohort study.

Background: Despite the standardization and optimization of disinfection protocols, duodenoscope-related infections (DRIs) remain an emerging threat for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Single-use duodenoscopes could represent a potential alternative avenue to circumvent the problem of reprocessing and thus risk of exogenous patient-to-patient transmission. The aim of our study was to test the feasibility and technical success rate of a recently made available single-use duodenoscope. Methods: We carried out a thorough and standardized evaluation of the usability, performance and safety of a recently developed single-use duodenoscope in 52 consecutive patients scheduled for ERCP in a single center. Outcomes included performance ratings of the single-use duodenoscopes, adverse events (assessed at 3 days and 1 week), and crossover rate to a reusable duodenoscope. Results: The ERCP completion rate with a single-use duodenoscope was 90.4%, rising to 94.2% after crossover to reusable duodenoscope. The mean American Society for Gastrointestinal Endoscopy (ASGE) grade was 2.7, with 27 procedures (51.9%) considered as advanced level complexity (ASGE grade 3 & 4). Performance rating found that 94% of the therapeutic treatments were comparable to those using a traditional reusable duodenoscope. Overall satisfaction amounted to 80%. No major adverse events were attributable to the single-use endoscope. Conclusions: Single-use duodenoscopes can provide an alternative to avoid the intensive and often inconsistent results of cleaning and disinfection procedures. We confirmed the feasibility, adequate performance characteristics and safety of a recently developed first-generation single-use duodenoscope over a broad range of ERCP procedures, in terms of both indication and complexity.