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Burdick's Technique for Biliary Access Revisited.

Goenka MK, Rai VK - Clin Endosc (2015)

Bottom Line: Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc.Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction.Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy.

View Article: PubMed Central - PubMed

Affiliation: Institute of Gastro Sciences, Apollo Gleneagles Hospitals, Kolkata, India.

ABSTRACT
The precut sphincterotomy is used to facilitate selective biliary access in cases of difficult biliary cannulation. Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc. Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction. Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy. In this review, we discuss this non-needle technique of precut sphincterotomy and also share our experience using this "Burdick's technique."

No MeSH data available.


Related in: MedlinePlus

(A) Formation of false tract. (B) Incision of false tract. (C) Selective biliary cannulation.
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Figure 1: (A) Formation of false tract. (B) Incision of false tract. (C) Selective biliary cannulation.

Mentions: After engaging the papilla, the papillotome tip is usually positioned in the 10 to 11 o'clock orientation and the position is often confirmed fluoroscopically. The papillotome is bowed and a hydrophilic guide wire is gently advanced under fluoroscopic guidance in the direction of the 10 to 11 o'clock position. Instead of entering the bile duct, the guide wire sometime exits the papilla at the 10 to 11 o'clock position, creating an intramural false passage (Fig. 1A). After confirming the position of guide wire below the horizontal fold in order to avoid duodenal perforation, the papillotome is then relaxed and passed over the guide wire which is visible across the ampulla. The papillotome wire is then flexed and the intramural segment incised by using a pure cutting electrosurgical current (Fig. 1B). Only the mucosal bridge of tissue proximal to the papilla is divided and that for only 1 to 2 cm above the sphincteric orifice, with the aim of exposing the submucosal structures. After this, the biliary and pancreatic orifices become clearly visible (Supplementary Video 1 [available online at http://www.e-ce.org/]). The transmural incision is completed and the bile duct is selectively cannulated in the conventional way (Fig. 1C).


Burdick's Technique for Biliary Access Revisited.

Goenka MK, Rai VK - Clin Endosc (2015)

(A) Formation of false tract. (B) Incision of false tract. (C) Selective biliary cannulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4323427&req=5

Figure 1: (A) Formation of false tract. (B) Incision of false tract. (C) Selective biliary cannulation.
Mentions: After engaging the papilla, the papillotome tip is usually positioned in the 10 to 11 o'clock orientation and the position is often confirmed fluoroscopically. The papillotome is bowed and a hydrophilic guide wire is gently advanced under fluoroscopic guidance in the direction of the 10 to 11 o'clock position. Instead of entering the bile duct, the guide wire sometime exits the papilla at the 10 to 11 o'clock position, creating an intramural false passage (Fig. 1A). After confirming the position of guide wire below the horizontal fold in order to avoid duodenal perforation, the papillotome is then relaxed and passed over the guide wire which is visible across the ampulla. The papillotome wire is then flexed and the intramural segment incised by using a pure cutting electrosurgical current (Fig. 1B). Only the mucosal bridge of tissue proximal to the papilla is divided and that for only 1 to 2 cm above the sphincteric orifice, with the aim of exposing the submucosal structures. After this, the biliary and pancreatic orifices become clearly visible (Supplementary Video 1 [available online at http://www.e-ce.org/]). The transmural incision is completed and the bile duct is selectively cannulated in the conventional way (Fig. 1C).

Bottom Line: Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc.Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction.Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy.

View Article: PubMed Central - PubMed

Affiliation: Institute of Gastro Sciences, Apollo Gleneagles Hospitals, Kolkata, India.

ABSTRACT
The precut sphincterotomy is used to facilitate selective biliary access in cases of difficult biliary cannulation. Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc. Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction. Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy. In this review, we discuss this non-needle technique of precut sphincterotomy and also share our experience using this "Burdick's technique."

No MeSH data available.


Related in: MedlinePlus