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Sequential double-guidewire technique and transpancreatic precut sphincterotomy for difficult biliary cannulation.

Kim CW, Chang JH, Kim TH, Han SW - Saudi J Gastroenterol (2015 Jan-Feb)

Bottom Line: When standard techniques were unsuccessful, DGT or NK was performed.Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023).In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background/aims: The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK).

Patients and methods: Six hundred and thirty-five consecutive patients with naοve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed.

Results: DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (P = 0.002). The cannulation rate was higher in the DGT ± TPS patients (85%) than in the NK patients (P = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (P = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023).

Conclusions: Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.

No MeSH data available.


Related in: MedlinePlus

Standard technique for biliary cannulation. (a) A sphincterotome with a guidewire was inserted into the bile duct via the papilla. (b) The common bile duct was opacified on the fluoroscopic image
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Figure 1: Standard technique for biliary cannulation. (a) A sphincterotome with a guidewire was inserted into the bile duct via the papilla. (b) The common bile duct was opacified on the fluoroscopic image

Mentions: As endoscopic retrograde cholangiopancreatography (ERCP) becomes almost exclusively therapeutic, the need to reliably achieve biliary access is an important prerequisite.[1] Accordingly, appropriate cannulation techniques during ERCP are essential, and these techniques may affect the development of post-ERCP pancreatitis (PEP). Established standard cannulation techniques are based on the initial contrast opacification of the desired duct using a standard ERCP cannula or sphincterotome [Figure 1].[2] With the advent of guidewires, guidewire-based techniques have been reported to confer some technical advantage for primary cannulation, which may reduce the incidence of PEP.[345] However, difficulties in selective cannulation of the bile duct with standard techniques including guidewire techniques are reported in approximately 3%-38% of ERCP procedures.[4567] In an attempt to overcome difficult biliary cannulation, several techniques have been developed. Among these, a needle-knife precut papillotomy (NK) is the most commonly used approach to open the biliary entrance, and this technique is generally successful when performed by an expert endoscopist.[89] Although NK is a useful technique, it has a higher rate of complications, which occur in 2%-34% of patients.[6101112] Furthermore, NK is somewhat technically demanding; therefore, it is generally reserved for experienced endoscopists.


Sequential double-guidewire technique and transpancreatic precut sphincterotomy for difficult biliary cannulation.

Kim CW, Chang JH, Kim TH, Han SW - Saudi J Gastroenterol (2015 Jan-Feb)

Standard technique for biliary cannulation. (a) A sphincterotome with a guidewire was inserted into the bile duct via the papilla. (b) The common bile duct was opacified on the fluoroscopic image
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4355857&req=5

Figure 1: Standard technique for biliary cannulation. (a) A sphincterotome with a guidewire was inserted into the bile duct via the papilla. (b) The common bile duct was opacified on the fluoroscopic image
Mentions: As endoscopic retrograde cholangiopancreatography (ERCP) becomes almost exclusively therapeutic, the need to reliably achieve biliary access is an important prerequisite.[1] Accordingly, appropriate cannulation techniques during ERCP are essential, and these techniques may affect the development of post-ERCP pancreatitis (PEP). Established standard cannulation techniques are based on the initial contrast opacification of the desired duct using a standard ERCP cannula or sphincterotome [Figure 1].[2] With the advent of guidewires, guidewire-based techniques have been reported to confer some technical advantage for primary cannulation, which may reduce the incidence of PEP.[345] However, difficulties in selective cannulation of the bile duct with standard techniques including guidewire techniques are reported in approximately 3%-38% of ERCP procedures.[4567] In an attempt to overcome difficult biliary cannulation, several techniques have been developed. Among these, a needle-knife precut papillotomy (NK) is the most commonly used approach to open the biliary entrance, and this technique is generally successful when performed by an expert endoscopist.[89] Although NK is a useful technique, it has a higher rate of complications, which occur in 2%-34% of patients.[6101112] Furthermore, NK is somewhat technically demanding; therefore, it is generally reserved for experienced endoscopists.

Bottom Line: When standard techniques were unsuccessful, DGT or NK was performed.Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023).In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Background/aims: The double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) are introduced as alternative biliary cannulation techniques for difficult biliary cannulation. This study aimed to evaluate the sequential use of DGT and TPS compared with a needle-knife precut papillotomy (NK).

Patients and methods: Six hundred and thirty-five consecutive patients with naοve papilla and who underwent endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation from March 2010 to April 2014 in a single institute were analyzed. When standard techniques were unsuccessful, DGT or NK was performed. TPS was sequentially performed if DGT failed.

Results: DGT and NK were attempted in 65 and 58 patients, respectively. A sequential DGT-TPS was performed in 38 patients after a failed DGT. Biliary cannulations were successful in 42%, 74%, and 66% of the DGT, sequential DGT-TPS, and NK patients, respectively (P = 0.002). The cannulation rate was higher in the DGT ± TPS patients (85%) than in the NK patients (P = 0.014). Post-ERCP pancreatitis (PEP) developed in 26% of the successful DGT patients, 37% of the sequential DGT-TPS patients, and 10% of the NK patients (P = 0.008). Of the sequential DGT-TPS patients, the incidence of PEP was significantly reduced in patients with a pancreatic duct (PD) stent compared with patients without a PD stent (24% vs. 62%, P = 0.023).

Conclusions: Sequential DGT-TPS is a useful alternative method compared with NK for patients in whom biliary cannulation is difficult. In the sequential DGT-TPS patients, the incidence of PEP was significantly reduced with the use of a PD stent.

No MeSH data available.


Related in: MedlinePlus