Application of needle-knife precut papillotomy in difficult common bile duct cannulation of endoscopic retrograde pancreatic duct radiography / 中国综合临床

Objective To investigate the effects and safety of needle?knife precut papillotomy in diffi?cult common bile duct cannulation of endoscopic retrograde pancreatic duct radiography ( ERCP ) . Methods The data of 104 cases treated with needle?knife precut papillotomy were retrospectively analyzed. The effect of pre incision and short?term complications were observed,and compared with 1326 cases( conventional group) of con?ventional selective intubation in the same period of ERCP. Results Successful cannulation of the bile duct was achieved in 97 of 104 patients who underwent needle?knife precut papillotomy, the total success rate was a?chieved in 93. 3%. The complications of needle?knife precut papillotomy occurred in 8 patients(7. 7%),inclu?ding mild bleeding in 4 cases,mild pancreatitis in 2 cases and billiary infection in 2 cases. There were 1326 ca?ses conventional selective intubation in the same period of ERCP,and 98 cases(7. 4%) with complication. There was no significant difference in the incidence of complications between the needle knife cut group and the con?ventional selective intubation group(χ2=0. 055,P>0. 05 ) . Conclusion In case of difficult common bile duct cannulation of ERCP,needle?knife precut sphincterotomy surgery can be safely and effectively catch the high ?ERCP the success of treatment,is worthy of wider application.

Feasibility of the Mucosa-Tracking Technique in Precut Papillotomy with the Iso-Tome as an Alternative to the Needle-Knife Technique

BACKGROUND/AIMS: The aim of this study was to evaluate whether the mucosa-tracking technique is effective for improving precutting-related pancreatitis and the sustained failure of bile duct cannulation in precut papillotomy (PP) with the Iso-Tome (MTW Endoskopie). METHODS: From September 2004 to June 2006, PP was performed with the Iso-Tome if biliary cannulation failed by conventional methods for approximately 5 minutes. The pink intrapapillary mucosa (PIPM) exposed by PP was tracked and classified into four groups: fully exposed and oriented to the direction of the bile duct (group A) or the pancreatic duct (group B), partially exposed (group C), or unexposed (group D). The success rate of bile duct cannulation (SRBC), the procedure time required for successful bile duct cannulation (PTBC), and the complications in the first session were compared between the mucosa-exposed groups (MEGs; group A, B, and C) and the mucosa-unexposed group (MUEG; group D). RESULTS: A total of 59 patients (25 females, 34 males) with a mean age of 65.2 years were enrolled. The MEGs and MUEG comprised 52 (88.1%) and 7 (11.9%) patients, respectively. SRBC in the first session was 86.4% (51/59) in total and 92.3% (48/52) in the MEGs, compared to only 42.9% (3/7) in the MUEG (p=0.005). The mean PTBC in the MEGs and MUEG was 8.7 minutes and 16.3 minutes, respectively (p=0.23). Complications occurred in 6.8% of the patients (4/59; all pancreatitis); there were no differences between the MEGs (5.8%, 3/52) and MUEG (14.3%, 1/7; p=0.41). All four patients with pancreatitis were managed medically. CONCLUSIONS: The mucosa-tracking technique in PP with the Iso-Tome is a feasible and useful method of enhancing SRBC. PIPM is an important endoscopic landmark for successful PP.

Risk Factors for Post-ERCP Pancreatitis after Needle Knife Sphincterotomy following Repeated Probing / 대한소화기내시경학회지

BACKGROUND/AIMS: Needle knife sphincterotomy (NKS) following repeated probing due to difficult cannulation during ERCP increase the risk of post-ERCP pancreatitis. However, the risk factors for post-ERCP pancreatitis are not well-known. The aim of this study is to investigate the incidence and risk factors of post-ERCP pancreatitis in patients who underwent NKS. We also evaluated the effect of gabexate on the prevention of post-ERCP pancreatitis. METHODS: Medical records from a total of 200 patients who underwent NKS following repeated probing during ERCP were reviewed retrospectively. The potential risk factors for post-ERCP pancreatitis were investigated. The effect of gabexate infusion after ERCP procedure on the incidence of post-ERCP pancreatitis was also evaluated. RESULTS: A total of 13 (6.5%) patients out of 200 patients developed post-ERCP pancreatitis. Gender, age, the presence of pancreatitis at procedure, underlyng disease, direction of sphincterotomy, success or failure of cannulation, diameter of CBD, pancreatic duct status and the presence of acinar filling were proved unrelated with pancreatitis. Post-ERCP pancreatitis developed in 9 out of 38 (23.7%) when gabexate was given, while 4 out of 160 (2.5%) experienced pancreatitis without administration of gabexate. CONCLUSIONS: We couldn't determine any risk factor for pancreatitis in patients who underwent NKS following repeated probing during ERCP. The gabexate infusion after ERCP procedure might be associated with the increased risk of pancreatitis.