Strategies for difficult endoscopic cannulation of major duodenal papilla / 中华消化内镜杂志

ABSTRACT

Objective To improve the success rate of selective cannulation of major papilla during endoscopic retrograde cholangiopancreatography (ERCP).Methods When cannulation failed with conventional methods,ultra-fine guide wire combined with taped cannulation,precut papillotomy,guide wire pancreatic occupation technique,and percutaneous transhepatic cholangial drainage (PTCD) assisted rendezvous technique was applied to improve the success rate of cannulation of major papilla.Results A total of 5743 patients received ERCP in our hospital during last 5 years,with a success rate of cannulation of major papilla at 98.6% (5664/5743).For 396 patients with difficult cannulation under conventional methods,ultra fine guide-wire technique was applied in 20,pancreatic occupation technique in 67,precut technique in 294 and PTCD assisted rendezvous technique in 15,which achieved a success rate of 80.0% (317/396).Conclusion Application of combined techniques according to the features of papilla can increase success rate of difficult cannulation.