Sa1505 Needle-Knife Precut Sphincterotomy With a Small Incision Made Possible by Prior Pancreatic Stent Placement Reduces the Complication Rate in Difficult Biliary Cannulation

Background. Transpancreatic precut sphincterotomy (TPS) is an option for difficult common bile duct (CBD) access, and the reports are few, with immediate success rate varying from 60 to 96%. The description of relation between the size of TPS and the immediate success rate of CBD cannulation was not found in the literature. The Aim of the Study. To evaluate the relation of large TPS to immediate success rate of CBD cannulation. Methods. A retrospective analysis was performed in prospectively collected data of 20 patients. TPS was performed with traction papillotome in the main pancreatic duct (MPD) directing towards 11 o’clock. Needle knife (NK) was used to enlarge TPS in five patients, and the other 15 cases had large TPS from the beginning of sphincterotomy. Prophylactic pancreatic stent was inserted in 18 cases, with diclofenac given in 12 cases. Results. The immediate success rate of CBD cannulation was 90% and with an eventual success rate of 100%. The failure in one immediate CBD cannulation with large TPS was due to atypical location of CBD orifice, and the other failed immediate CBD cannulation was due to inadequate size of TPS. Complications included 3 cases of post-TPS bleeding and 3 cases of mild pancreatitis. Conclusion. TPS is an effective procedure in patients with difficult biliary access and can have high immediate success rate with large TPS.

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Needle-knife sphincterotomy over a pancreatic stent (NKPS) in difficult biliary cannulation but incidental selective pancreatic duct (PD) cannulation

Pancreatology ◽

10.1016/j.pan.2014.05.451 ◽

2014 ◽

Vol 14 (3) ◽

pp. S23

Author(s):

Eun Kwang Choi ◽

Seung Uk Jeong ◽

Heung Up Kim

Keyword(s):

Pancreatic Duct ◽

Pancreatic Stent ◽

Biliary Cannulation ◽

Difficult Biliary Cannulation ◽

Needle Knife

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Needle-knife precut papillotomy with a small incision over a pancreatic stent improves the success rate and reduces the complication rate in difficult biliary cannulations

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1007/s00534-012-0552-4 ◽

2012 ◽

Vol 20 (3) ◽

pp. 382-388 ◽

Cited By ~ 18

Author(s):

Kensuke Kubota ◽

Takamitsu Sato ◽

Shingo Kato ◽

Seitaro Watanabe ◽

Kunihiro Hosono ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Pancreatic Stent ◽

Small Incision ◽

Needle Knife

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Comparison of sequential pancreatic duct guidewire placement technique and needle knife precut sphincterotomy for difficult biliary cannulation

Journal of Digestive Diseases ◽

10.1111/1751-2980.12300 ◽

2015 ◽

Vol 16 (12) ◽

pp. 741-746 ◽

Cited By ~ 3

Author(s):

Xiao Ping Zou ◽

Joseph W. Leung ◽

Yun Hong Li ◽

Yu Ling Yao ◽

Qing Shan Pei ◽

...

Keyword(s):

Pancreatic Duct ◽

Biliary Cannulation ◽

Difficult Biliary Cannulation ◽

Needle Knife ◽

Precut Sphincterotomy ◽

Placement Technique

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Biliary cannulation in endoscopic retrograde cholangiography: How to tackle the difficult papilla

Digestive Diseases ◽

10.1159/000515692 ◽

2021 ◽

Author(s):

Mark op den Winkel ◽

Jörg Schirra ◽

Christian Schulz ◽

Enrico N. De Toni ◽

Christian J. Steib ◽

...

Keyword(s):

Biliary Drainage ◽

Guide Wire ◽

A Priori ◽

Endoscopic Retrograde Cholangiography ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Increased Risk ◽

Difficult Biliary Cannulation ◽

Needle Knife ◽

Transpancreatic Sphincterotomy

Background: In the setting of a naïve papilla, biliary cannulation is a key step in successfully performing endoscopic retrograde cholangiography (ERC). Difficult biliary cannulation (DBC) is associated with an increased risk of post-ERCP-pancreatitis and failure of the whole procedure. Summary: Recommendations for biliary cannulation can be divided in (a) measures to reduce the likelihood of a difficult papilla-situation a priori and (b) rescue techniques in case the endoscopist is actually facing DBC. (a): careful inspection of the papillary anatomy and optimizing its accessibility by scope-positioning is fundamental. A sphincterotome in combination with a soft-tip hydrophilic guide-wire rather than a standard catheter with a standard guide-wire should be used. (b): The most important rescue techniques are needle-knife precut, double-guidewire technique and transpancreatic sphincterotomy. In few cases, anterograde techniques are needed. To this regard, the EUS-guided biliary drainage (EUS-BD) followed by rendezvous is increasingly used as an alternative to percutaneous-transhepatic biliary drainage. Key Messages: Biliary cannulation can be accomplished with alternative retrograde or less frequently by salvage-anterograde techniques, once conventional direct cannulation attempts have failed. Considering recent favorable data for the early use of transpancreatic sphincterotomy, an adopted version of the 2016 European-Society-for-Gastrointestinal-Endoscopy (ESGE)-algorithm on biliary cannulation is proposed.

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