Comparison of sequential pancreatic duct guidewire placement technique and needle knife precut sphincterotomy for 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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Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy (with video)

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2009.08.028 ◽

2010 ◽

Vol 71 (2) ◽

pp. 275-279 ◽

Cited By ~ 29

Author(s):

Gregory A. Coté ◽

Michael Ansstas ◽

Rishi Pawa ◽

Steven A. Edmundowicz ◽

Sreenivasa S. Jonnalagadda ◽

...

Keyword(s):

Pancreatic Duct ◽

Biliary Cannulation ◽

Pancreatic Duct Stent ◽

Difficult Biliary Cannulation ◽

Precut Sphincterotomy

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

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2011.03.239 ◽

2011 ◽

Vol 73 (4) ◽

pp. AB191

Author(s):

Kensuke Kubota ◽

Akito Oshima ◽

Seitaro Watanabe ◽

Noritoshi Kobayashi ◽

Atsushi Nakajima

Keyword(s):

Stent Placement ◽

Complication Rate ◽

Pancreatic Stent ◽

Biliary Cannulation ◽

Small Incision ◽

Difficult Biliary Cannulation ◽

Needle Knife ◽

Precut Sphincterotomy

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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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Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial

Endoscopy ◽

10.1055/a-1327-2025 ◽

2021 ◽

Author(s):

Leena Kylänpää ◽

Vilja Koskensalo ◽

Arto Saarela ◽

Per Ejstrud ◽

Marianne Udd ◽

...

Keyword(s):

Pancreatic Duct ◽

Controlled Trial ◽

Good Alternative ◽

Endoscopic Retrograde ◽

Biliary Cannulation ◽

Randomized Controlled ◽

Biliary Sphincterotomy ◽

Difficult Biliary Cannulation ◽

Definition Of ◽

Randomized Method

Abstract Background Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of post-ERCP pancreatitis (PEP). The purpose of this prospective, randomized, multicenter study was to compare two advanced rescue methods, transpancreatic biliary sphincterotomy (TPBS) and a double-guidewire (DGW) technique, in difficult common bile duct (CBD) cannulation. Methods Patients with native papilla and planned CBD cannulation were recruited at eight Scandinavian hospitals. An experienced endoscopist attempted CBD cannulation with wire-guided cannulation. If the procedure fulfilled the definition of difficult cannulation and a guidewire entered the pancreatic duct, randomization to either TPBS or to DGW was performed. If the randomized method failed, any method available was performed. The primary end point was the frequency of PEP and the secondary end points included successful cannulation with the randomized method. Results In total, 1190 patients were recruited and 203 (17.1 %) were randomized according to the study protocol (TPBS 104 and DGW 99). PEP developed in 14/104 patients (13.5 %) in the TPBS group and 16/99 patients (16.2 %) in the DGW group (P = 0.69). No difference existed in PEP severity between the groups. The rate of successful deep biliary cannulation was significantly higher with TPBS (84.6 % [88/104]) than with DGW (69.7 % [69/99]; P = 0.01). Conclusions In difficult biliary cannulation, there was no difference in PEP rate between TPBS and DGW techniques. TPBS is a good alternative in cases of difficult cannulation when the guidewire is in the pancreatic duct.

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Evaluation of Early Precut with Needle-Knife in Difficult Biliary Cannulation During ERCP

Digestive Diseases and Sciences ◽

10.1007/s10620-013-2834-3 ◽

2013 ◽

Vol 58 (12) ◽

pp. 3606-3610 ◽

Cited By ~ 4

Author(s):

Jian-hong Zhu ◽

Qiang Liu ◽

De-qing Zhang ◽

Huang Feng ◽

Wei-chang Chen

Keyword(s):

Biliary Cannulation ◽

Difficult Biliary Cannulation ◽

Needle Knife

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Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

Frontline Gastroenterology ◽

10.1136/flgastro-2019-101380 ◽

2020 ◽

pp. flgastro-2019-101380

Author(s):

Jared Rejeski ◽

Marc Hines ◽

Jason Jones ◽

Jason Conway ◽

Girish Mishra ◽

...

Keyword(s):

High Volume ◽

Complication Rates ◽

Success Rates ◽

Biliary Cannulation ◽

Pancreatic Duct Stenting ◽

Significant Difference ◽

Effective Option ◽

Needle Knife ◽

Precut Sphincterotomy ◽

Rectal Indomethacin

GoalsOur study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.BackgroundComplication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.StudyWe performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.ResultsWe identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p<0.001).ConclusionThis data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.

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