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EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

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EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zhen Li 1, Yile Zeng 1, Zefeng Xing 1

Affiliations

1 Qilu Hospital of Shandong University, Jinan, China

Summary

AI Generated

A randomized controlled trial of 208 patients demonstrated that performing EUS immediately before ERCP significantly improved treatment strategy concordance (89.7% vs 71.8%, P=0.002) and avoided unnecessary ERCP in 17.1% of cases.

Among 208 randomized patients (105 EUS+ERCP, 103 ERCP alone), strategy concordance between planned and actual intervention was significantly higher with pre-ERCP EUS (89.7% vs 71.8%, P=0.002).
EUS findings precluded the need for ERCP in 18 patients (17.1%) in the EUS+ERCP group, safely avoiding unnecessary procedures.
The EUS+ERCP group had significantly lower fluoroscopy time, radiation dose, DAP, and ERCP procedure time compared to ERCP alone (all P<0.05).
No significant differences were observed between groups in technical success, difficult cannulation, total procedure time, or complication rates (all P>0.05).
The findings suggest pre-procedural EUS should be considered when feasible for patients with an ERCP indication to optimize clinical decision-making.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Endoscopic Ultrasonography (EUS) is increasingly being used in preoperative examinations in pancreatobiliary diseases for Endoscopic retrograde cholangiopancreatography (ERCP). However, it has never been tested in a randomized trial. This study aims to investigate the clinical value of performing EUS prior to ERCP versus performing conventional ERCP alone, focusing on avoiding unnecessary procedures, ensuring treatment concordance, reducing radiation exposure, and preventing complications.

Aims & Methods

In this single-center, parallel-group randomized controlled trial, patients with pancreaticobiliary diseases and a clear indication for ERCP were enrolled. Using a random number table, participants were assigned to either the EUS+ERCP group or the ERCP alone group. The primary outcomes were the rate of avoided unnecessary ERCP and the concordance rate between actual and initially planned interventional strategies. Secondary outcomes included technical success, difficult cannulation, procedure time, radiation dose, and complications.

Results

A total of 208 patients were randomized (105 to EUS+ERCP, 103 to ERCP alone). In the EUS+ERCP group, ERCP was avoided in 18 patients (17.1%) because EUS findings precluded the need for intervention. Among patients who proceeded to ERCP, the strategy concordance rate was significantly higher in the EUS+ERCP group (78/87, 89.7%) than in the ERCP alone group (74/103, 71.8%) (P = 0.002). The EUS+ERCP group also had significantly lower fluoroscopy time, radiation dose, DAP (Dose area product), and ERCP procedure time (P < 0.05). No significant differences were observed between groups in technical success, difficult cannulation, total procedure time, or complication rates (all P>0.05).

Conclusion

Performing EUS prior to ERCP significantly improves concordance between the interventional strategy and the procedure, safely reduces unnecessary ERCP procedures, and lowers radiation exposure. These findings suggest that pre-procedural EUS should be considered, when feasible, for patients with an indication for ERCP to optimize clinical decision-making.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Endoscopy: Taming the biliary tree

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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