B0001 - Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients With Situs Inversus Viscerum

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Nicholas McDonald, MD

University of Minnesota
Minneapolis, MN

Nicholas McDonald, MD¹, Long Le, MD¹, Harikrishna Halaharvi, MD¹, Westanmo Anders, ², Mohammad Bilal, MD³, Dharma Sunjaya, MD³
¹University of Minnesota, Minneapolis, MN; ²Minneapolis VA, Minneapolis, MN; ³University of Minnesota, Minneapolis VA Medical Center, Minneapolis, MN

Introduction: Situs inversus (SIV) is a rare congenital condition defined by the left to right transposition of all viscera as a mirror image. This uncommon anatomic variant has been reported to cause technical challenges while performing endoscopic retrograde cholangiopancreatography (ERCP). Data of patients with situs inversus undergoing ERCP is limited to case reports and the clinical and technical success rate of ERCP in these patients is unknown. The goal of our study is to evaluate the clinical and technical success rates and procedural characteristics of patients with situs inversus undergoing ERCP.

Methods: A retrospective review of data from consecutive patients with SIV undergoing ERCP. Data was collected by querying the nationwide Veterans Affairs Health System database for patients with a diagnosis of situs inversus (ICD Q89.3) who underwent ERCP between January 1, 2010, to March 31, 2022. Patient demographic and procedure characteristics were collected (Table 1).

Results: A total of 654 patients with situs inversus were identified. Eight of these patients had undergone ERCP. The median age was age of 68. The most common indication for ERCP was choledocholithiasis (5 patients, 62.5%). The technical success rate (defined as ability to achieve successful biliary cannulation) was 63%. Subsequent ERCP with interventional radiology assisted rendezvous increased the technical success rate to 88%. Clinical success (defined as successful management of choledocholithiasis, cholangitis, stricture, or obtaining specimens for the diagnosis of malignancy) was achieved in 63% of cases. When considering subsequent rendezvous ERCP if conventional ERCP failed, clinical success was achieved in 88% of cases.

Discussion: In our limited series, the clinical and technical success rate of ERCP for patients with SIV is higher than previously reported. In patients with SIV where conventional ERCP biliary cannulation fails, IR assisted rendezvous ERCP can be considered.

Gender	Race	Age	Indication	Technical Success	Clinical Success	Reason for failure	Rendezvous ERCP attempted	Rendezvous ERCP technically successful	Rendezvous ERCP clinically successful
Male	White	72	Choledocholithiasis	Yes	Yes
Male	African American	74	Pancreatic adenocarcinoma	Yes	Yes
Male	White	88	Choledocholithiasis with cholangitis	No	No	Unable to cannulate the ampulla	Yes	Yes	Yes
Male	White	62	Periampullary Adenocarcinoma	Yes	Yes
Male	White	59	Choledocholithiasis	No	No	Unable to cannulate the ampulla	No
Male	White	88	Choledocholithiasis	Yes	Yes
Female	Native American	63	Benign biliary stricture	Yes	Yes
Male	Hispanic	63	Choledocholithiasis with cholangitis	No	No	Unable to visualize the ampulla	Yes	Yes	Yes

Disclosures:

Nicholas McDonald indicated no relevant financial relationships.

Long Le indicated no relevant financial relationships.

Harikrishna Halaharvi indicated no relevant financial relationships.

Westanmo Anders indicated no relevant financial relationships.

Mohammad Bilal indicated no relevant financial relationships.

Dharma Sunjaya indicated no relevant financial relationships.

Nicholas McDonald, MD¹, Long Le, MD¹, Harikrishna Halaharvi, MD¹, Westanmo Anders, ², Mohammad Bilal, MD³, Dharma Sunjaya, MD³. B0001 - Outcomes of Endoscopic Retrograde Cholangiopancreatography in Patients With Situs Inversus Viscerum, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.