Aims
A recent meta-analysis (Beran et al., 2024) showed that overall risk of post-ERCP pancreatitis is approximately 5.4%. Previous studies comparing same-session EUS tissue acquisition and ERCP with separate procedures did not show a significant difference in the incidence of Post-Procedure Pancreatitis (PPP). However, the absolute incidence of PPP was high, at 19% in the same session arm and 12% in the separate session group (Gorris et al., 2022). Hence, we analyzed our database to ascertain the risk of PPP in same-session interventions.
Methods
Single center retrospective analysis of all patients undergoing the same session EUS ERCP for head of pancreas mass from July 2019 to November 2025. All procedures were performed by single endoscopist (MD). Outcomes, including technical success, clinical success, FNA results, and immediate and long-term adverse events (AE), were analyzed.
Results
37 patients with pancreatic head masses underwent index EUS ERCP as part of the diagnostic workup. FNA was performed on all patients (100%), with a 25-gauge needle in 13 patients (35%), a 22-gauge needle in 16 patients (43%), and both needles in 8 patients (22%). FNA access was transduodenal (TD) in 35 patients (95%) and transgastric (TG) in 3 patients (8%). On average, three passes were performed per patient. Rapid on-site evaluation (ROSE) for preliminary cytologic exam and specimen adequacy was available for all patients. Same-session biliary cannulation was successful in 28 patients (76%), while the rest underwent Percutaneous Transhepatic catheter with drain. Prophylactic rectal NSAID were administered to 33 patients (89%), and 24 patients (65%) received periprocedural IV hydration with lactated Ringer's solution. Overall, the incidence of AE was low, and the specific incidence of PPP was 2.7% (1/37). (Table 1)
| Category | Data |
| Age | Mean ≈ 75.7 years |
| Sex (M/F) | 16 : 21 |
| Fine Needle Aspiration Performed | 100% |
| Needle Gauge Usage | • 22G only: 43.2% (16/37)• 25G only: 35.1% (13/37)• Both 22G & 25G: 21.6% (8/37) |
| Total Passes (by Gauge) | • 22G: 67 passes (54.5%)• 25G: 57 passes (45.5%) |
| Average Number of Passes per Gauge | • 22G: 67 ÷ 24 = 2.79• 25G: 57 ÷ 21 = 2.71 |
| Endoscopic Ultrasound Route | • Transduodenal (TD): 35/37 (94.6%)• Transgastric (TG): 3/37 (8.1%) |
| Same-session Biliary Cannulation | 28/37 (75.7%) |
|
Percutaneous Transhepatic Catheter with Drain |
10/37 (27%) |
| Stent Placement | • Stent placed: 27/37 (73%)• No stent placed: 10/37 (27%) |
| Type of Biliary Stent (Among 27 placed) | • Plastic: 11/27 (40.7%)• Uncovered metal: 7/27 (25.9%)• Covered metal: 11/27 (40.7%) |
| Prophylaxis | • NSAIDs: 33/37 (89.2%)• IV fluids: 24/37 (64.9%) |
| Complication | Post-ERCP Pancreatitis: 1/37 (2.7%) |
Conclusions
Same session EUS guided tissue acquisition and ERCP for the head of pancreas mass may have lower risk for PPP than previously reported. The availability of ROSE, appropriate number of FNA passes, endoscopist with advanced technical expertise, case complexity, prophylactic rectal NSAIDs, and IV fluids could have positively impacted the risk of PPP in our study.