scholarly journals Transpancreatic Precut Sphincterotomy for Biliary Access: The Relation of Sphincterotomy Size to Immediate Success Rate of Biliary Cannulation

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Lien-Fu Lin
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Success Rate ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
The Other ◽  
Pancreatic Stent ◽  
Biliary Cannulation ◽  
Needle Knife ◽  
Precut Sphincterotomy

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.

scholarly journals A case of double gallbladder with separated orifices of common bile duct and main pancreatic duct, complicated with cholelithiasis

2005 ◽  
Vol 67 (2) ◽  
pp. 136-137
Author(s):  
Mayumi Miyazawa ◽  
Yutaro Kubota ◽  
Ayako Hiraide ◽  
Tadashi Honma ◽  
Katsuya Kitamura ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Double Gallbladder

scholarly journals Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

2020 ◽  
Author(s):  
Kai-Shun Liang ◽  
Chieh-Chang Chen ◽  
Wei-Chih Liao ◽  
Yu-ting Kuo ◽  
Liang-Wei Tseng ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bile Duct ◽  
Adverse Events ◽  
Success Rate ◽  
University Hospital ◽  
Access Methods ◽  
Biliary Cannulation ◽  
Access Rate ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

Abstract Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF. Aims To investigate the success rate and complications of NKF and TPS in patients with difficult biliary access. Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed. Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred. Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.

scholarly journals A CASE OF PAPILLA OF VATER CANCER WITH SEPARATED ORIFICES OF COMMON BILE DUCT AND MAIN PANCREATIC DUCT

2006 ◽  
Vol 67 (11) ◽  
pp. 2613-2616
Author(s):  
Yutaka TAMAMORI ◽  
Hiroji NISHINO ◽  
Yukio NISHIGUCHI ◽  
Nobuya YAMADA ◽  
Yong-Eun LEE ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Papilla Of Vater

scholarly journals Management of biliary diseases after the failure of initial needle knife precut sphincterotomy for biliary cannulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min-Hao Lo ◽  
Cheng-Hui Lin ◽  
Chi-Huan Wu ◽  
Yung-Kuan Tsou ◽  
Mu-Hsien Lee ◽  
...  
Keyword(s):  
Bile Duct ◽  
Alternative Therapy ◽  
Length Of Hospital Stay ◽  
Time Interval ◽  
Significant Finding ◽  
Invasive Treatment ◽  
Biliary Cannulation ◽  
Needle Knife ◽  
Duct Stricture ◽  
Precut Sphincterotomy

AbstractEndoscopic retrograde cholangiopancreatography is not always successful even with needle knife precut sphincterotomy (NKPS). How to manage these patients with initial NKPS failure has not been well studied. We report the outcomes of patients who received endoscopic and non-endoscopic rescue treatment after the initial NKPS failure. During the 15 years from 2004 to 2018, 87 patients with initial NKPS failure received interval endoscopic treatment (IET group, n = 43), percutaneous transhepatic biliary drainage (PTBD group, n = 25), or bile duct surgery (BDS group, n = 19) were retrospectively studied. Compared with the PTBD group, the prevalence of choledocholithiasis was higher (69.8% vs. 16.0%, p < 0.001), and malignant bile duct stricture were lower (20.9% vs. 76.0%, p < 0.001) in the IET group. Furthermore, the IET group had a significantly longer time interval between the first and second treatment procedures (4 days vs. 2 days, p = 0.001), a lower technique success rate (79.1% vs. 100%, p = 0.021), and a shorter length of hospital stay (7 days vs. 18 days, p < 0.001). Compared to the BDS group, the only significant finding was that the patients in the IET group were older. Although not statistically significant, the complication rate was lowest in the IET group (7.0%) while highest in the BDS group (15.8%). Complications in the IET group were also mild, as compared with the other two groups. In conclusion, IET should be considered after initial failed NKPS for deep biliary cannulation before contemplating more invasive treatment such as BDS. PTBD may be the alternative therapy for patients with malignant biliary obstruction.

Case 4.1

2014 ◽  
pp. 189-190
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
The Body ◽  
Developmental Anomaly ◽  
Minor Papilla ◽  
Pancréas Divisum ◽  
The Common

51-year-old man with possible cholangiocarcinoma MIP image from 3D FRFSE MRCP (Figure 4.1.1) demonstrates that the main pancreatic duct drains into the duodenum at the minor papilla, separate from the common bile duct. Pancreas divisum Pancreas divisum is the most common pancreatic developmental anomaly, with an estimated prevalence of 4% to 15%. It occurs when the ducts of the dorsal and ventral pancreatic buds fail to fuse. This results in the main pancreatic duct draining into the duodenum at the minor papilla via the duct of Santorini, separate from the common bile duct, which drains into the major papilla. (With normal development, the ventral duct of Wirsung fuses with the main pancreatic duct of the body and tail and drains into the major papilla with the common bile duct.)...

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