Precorte de papila de vater. Evaluacion prospectiva de frecuencia de uso, eficacia, complicaciones y mortalidad. Estudio cooperativo del Noroeste de la Provincia de Buenos Aires / Precut Vaters papilla. Prospective evaluation of frequency of use, effectiveness, complication and mortality. Cooperative study in thenorthwest of the province of Buenos Aires

ABSTRACT

1) INTRODUCTION: Precut papillotomy, has been considered a potentially dangerous procedure. In spite of this, numerous national and foreign referral centers have reported good results with the use of this technique that increases the cannulation rate and permits additional therapeutic procedures. 2) OBJECTIVES: We evaluated the procedure in terms of frequency of use, effectiveness, complications and mortality. 3) PATIENT AND METHODS: Between January 1, 1996 and December 31, 1999, 419 ERCP were performed in our centers. We used precut papillotomy in 51 patients. Inclusion criteria for precut papillotomy protocol were 1 precut papillotomy indication. 1-1 failure to cannulate the papilla, 1-2 appropriate indication, 1-3 Expert endoscopist, 2 complete follow up, 3 informed consent. The experimental design of the study was prospective. When the patients entered into the protocol, they underwent a needle-knife sphincterotomy according to Huibregise's technique. The follow up was done during 30 days, with a clinical examination, laboratory test and ultrasonography all of them weekly, to determine the possible complications according to Cotton's criteria and the mortality. 4) RESULTS: 4-1) Precut frequency 51 patients (pts.) (12.1 percent). 4-2) Follow up 49 pts. (96.1 percent) fulfilled the weekly controls; 2 pts. (3.9 percent) did not come for the controls. 4-3) Sex and Age Women 29 pts. (56.9 percent). Age 62.5 +/- 1.74 years. Men 22 pts. (43.1 percent) Age +/- 3.35 years. 4-4) Indications Jaundice, diagnosis and treatment 44 pts. (86.3 percent), post-cholecystectomy pain; 4 pts. (7.8 percent), and idiopathic abdominal pain 3 pts. (5.9 percent). 4-5) Effectiveness First attempt 35 pts. (71.4 percent), second attempt 10 pts (20.4 percent). Definite effectiveness 45 pts. (98.1 percent), failure 4 pts. (8.1 percent). 4-6) Complementary treatment in 43 pts. we performed the following procedures papillotomy and stone extraction 26 pts. (53 percent), papillotomy and prosthesis 9 pts. (18.4 percent), Prosthesis 8 pts. (16.3 percent, only pre-cut papillotomy 6 pts. (12.2 percent). 4-7 Final diagnoses Coledocholithiasis 41 pts. (83.6 percent); Malignant obstruction of biliary duct 4 pts. (8.2 percent), Pancreatic Cancer 1 pts. (2 percent); Ampullary Cancer 1 pts. (2 percent). Oddi sphyncter dysfunction 1 pts. (2 percent). 4-8...