3D-assisted ERCP enhances cannulation efficiency in malignant biliary obstruction: a prospective two-center study.

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary drainage is the standard treatment for malignant biliary obstruction in patients who are not candidates for curative surgery. However, ERCP can be more challenging in patients with pancreatic cancer complicated by obstructive jaundice, often leading to prolonged cannulation times. This study aimed to evaluate the efficacy of three-dimensional (3D) reconstruction-assisted ERCP in treating patients with pancreatic cancer complicated by malignant biliary obstruction.

METHODS

We performed a two-center prospective study including 72 patients diagnosed with pancreatic cancer complicated by obstructive jaundice. The 36 patients who underwent 3D reconstruction before ERCP constituted the intervention group, while the remaining patients, who received conventional ERCP without 3D assistance, served as the control group. Outcomes evaluated included technical success, procedure duration, X-ray exposure time, clinical success (defined as a ≥50% reduction in serum bilirubin within 5 days), and adverse events.

RESULTS

3D models were successfully constructed for patients in the intervention group and were used for both preoperative planning and intraoperative guidance during ERCP. Compared to conventional ERCP, 3D-assisted ERCP significantly reduced cannulation time (16 min [IQR: 13-30] vs. 13.5 min [IQR: 9-21], P = 0.036) and X-ray exposure time (40.5 s [IQR: 28-69] vs. 34.5 s [IQR: 24-45.5], P = 0.034) for both patients and physicians. No significant differences were observed between the two groups in terms of technical success rates (97.2% vs. 100%, P = 1), clinical success rates (77.8% vs. 83.3%, P = 0.77) or adverse event rates (19.44% vs. 13.89%, P = 0.75). Additionally, no procedure-related mortality occurred.

CONCLUSIONS

3D-assisted ERCP significantly reduces the X-ray exposure time and shortens cannulation time for both patients and physicians, making it a valuable tool for treating malignant biliary obstruction.

HIGHLIGHTS: This prospective two-center study demonstrates that 3D reconstruction-assisted ERCP can significantly reduce X-ray exposure time and overall procedure duration, thereby enhancing safety and efficiency in the management of malignant biliary obstruction.