ABSTRACT
Endoscopic retrograde cholangiopancreatography(ERCP)is a well-established advanced endoscopic technique for the diagnosis and treatment of pancreatobiliary diseases. New advances have been made in the treatment concept and techniques of ERCP in recent years. This article elaborates on the recent advances in ERCP,including the application of pancreatic duct stent,non-steroidal anti-inflammatory drugs,and aggressive hydration to prevent postoperative pancreatitis,covered metal stent for the treatment of benign bile duct stenosis,in-traluminal radiofrequency ablation for malignant bile duct stenosis,extracorporeal shockwave lithotripsy and covered metal stent for the treat-ment of chronic pancreatitis,peroral choledochoscopy for qualitative diagnosis of bile duct stenosis and huge refractory stones,definition of difficult intubation,timing of pre-cut technique,and ERCP after gastrointestinal reconstruction.
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Objective To evaluate the applicability and security of transpancreatic precut sphincterotomy vs double guidewire technique for cannulation in difficult bile duct cannulation in endoscopic retrograde eholangiopancreatography (ERCP). Methods Retrospective analysis of 158 cases difficult bile duct cannulation in ERCP from January 2012 to January 2014, according to the intubation tube method, we divided all the cases into 3 groups, transpancreatic precut sphincterotomy group (group A); double guide wire technique group (group B); single guide wire technique group (group C). Then compare the intubation success rate and the incidence of complications among the 3 groups. Results 54 of 58 patients in group A intubation successful, the success rate is 93.1%, 50 of 56 patients in group B intubation successful, the success rate is 89.3%, 26 of 44 patients in group C intubation successful, the success rate is 59.1%, there was no significant difference between group A and B(P > 0.05), group A and group C, group B and C have significant difference (P 0.05), group A and group C, B and C complication rates had significant difference (P < 0.05). Conclusions When selective bile duct intubation is difficulty and guide wire thread into the pancreatic duct, continue to single guide wire have low intubation success rate and higher incidence of complications,transpancreatic precut sphincterotomy and double guide wire technique can effectively improve the success rate of intubation, and complication rates are relatively low, no significant difference between the two.
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."
Subject(s)
Bile Ducts , Catheterization , Hemorrhage , Pancreatitis , Standard of CareABSTRACT
La canulación fallida del conducto biliar común durante la colangiopancreatografía retrógrada endoscópica es del 5 al 20% según la experticia del operador. El uso de guías hidrofílicas y la canulación profunda y selectiva son claves en el adecuado abordaje de la vía biliar. La inadecuada selección del paciente, papilas pequeñas o peridiverticulares, cálculo impactado, disfunción del Oddi o traumatismo repetido durante la canulación son las causas más frecuentes. La esfinterotomía de aguja en sus dos modalidades infundibulotomía y el precorte son técnicas opcionales para el abordaje del conducto biliar ante el fallo de la técnica convencional. Ambas técnicas son igualmente efectivas para el abordaje biliar en coledocolitiasis. La hiperamilasemia es más frecuente en el precorte (17.75%) en infundibulotomía (2.7%). La incidencia de pancreatitis post colangiografía es de 15% posterior a 15 o más intentos de canulación. La pancreatitis en el precorte puede alcanzar el 8% y es rara durante la infundibulotomía. El sangramiento ocurre de forma comparable con ambas técnicas. La esfinterotomía de aguja temprana en la canulación fallida disminuye la ocurrencia de pancreatitis post procedimiento. Debe ser realizada por colangiografistas expertos en la técnica y manejo de las complicaciones y contarse con los equipos y materiales adecuados
The failed cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography is from 5 to 20% depending on operator expertise. The use of hydrophilic guides and the deep and selective cannulation are key to sucessfull access to the bile duct. Inadequate patient selection, small duodenal papilla or peridiverticular, impacted gallstone, Oddi dysfunction or repeated trauma during cannulation are the most common causes of failure. Needle-knife sphincterotomy in its two modalities: infundibulotomy and precut are optional techniques for accessing the bile duct when confronted with the conventional technique failure. Both techniques are equally effective for biliary choledocholithiasis. Hyperamylasemia is more common in the precut (17.75%) infundibulotomy (2.7% ). The incidence of post cholangiography pancreatitis is 15% after 15 or more cannulation attempts. Pancreatitis in precut can reach 8% and is rare during the infundibulotomy. Bleeding occurs in a similar way in both techniques. Early needle-knife use, in failed in cannulation decreases the occurrence of post procedure pancreatitis. It must be perfomed by experts in the technique that are able to manage eventual complications beside having adequate equipment and materials available
Subject(s)
Female , Catheterization/methods , Common Bile Duct/cytology , Diagnostic Techniques and Procedures , Sphincterotomy, Endoscopic/methods , GastroenterologyABSTRACT
Objective To evaluate the endoscopic precut sphincterotomy for malignant biliary obstruction. Methods Endoscopic precut sphincterotomy was performed in different ways for 46 patients with malignant biliary obstruction and difficult biliary cannulation according to the anatomic structure of the papilla and cannulation. Ways of precut were summarized and complications were analyzed. Results Precut sphincterotomy was performed with bow-like knife in 4 patients, with needle-knife in 24, with trans-pancreatic sphincterotomy in 12 and with combined ways in 6. The procedure succeeded in 35 cases (76. 1%, 35/46). Post-procedure complications included bleeding in 3 patients, pancreatitis in 1, hyper-amylasemia in 2and cholangitis in 1. No perforation was found. Conclusion Endoscopic precut sphincterotomy is not only able to improve the therapeutic endoscopy achievement rate in patients with malignant biliary obstruction, but also to lower the incidence of complications if used adequately.
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Objective To evaluate the application of endoscopic needle- knife precut sphincterotomy (PST) in treating acute suppurative cholangitis. Methods After failure of routine papillary intubation during encoscopic retrograde cholangio-pancreatography (ERCP) in papillary incarcerated stone or inflammatory stenosis cases, needle-knife PST was applied to find the lower opening of the common bile duct. After that, routine papillary sphincterotomy or balloon dilation followed. Then net basket for stone extraction and nasobiliary catheter for drainage were made. Results Eleven of the 12 cases′ stones were extracted successfully, the success rate was 91.7%. In the 11 cases, 5 cases′ incarcerated stones dropped into duodenum automatically after sphincterotomy; 9 cases′ stones were extracted successfully in one treatment while 2 cases′ stones were extracted secondarily after stents were implanted; 1 case′s stone could not be extracted and need surgical treatment after nasobiliary catheter drainage because of stenosis of the lower part of the common bile duct. There was no dead case in all the cases. Conclusions Acute suppurative cholangitis patients, who have papillary incarcerated stones or inflammatory stenosis, can receive more efficacious diagnosis and treatment by applying PST when routine endoscopic papillary intubation fails. PST is an important endoscopic treatment for acute calculous suppurative cholangitis