scholarly journals A Novel Round Insulated Tip Papillotome as an Alternative to the Classic Needle-Knife for Precut Sphincterotomy in Endoscopic Retrograde Cholangiopancreatography

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Birol Baysal ◽  
Hakan Akin ◽  
Omar Masri ◽  
Ali Tüzün İnce ◽  
Hakan Senturk
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Efficacy And Safety ◽  
Endoscopic Retrograde ◽  
Exclusion Criteria ◽  
Biliary Cannulation ◽  
Successful Cannulation ◽  
Significant Difference ◽  
Associated Conditions ◽  
Needle Knife ◽  
Precut Sphincterotomy

Objective. The purpose of this study was to investigate the efficacy and safety of a new round insulated tip papillotome (r-ITP) as compared to that of the classic needle-knife sphincterotome (NKS) in difficult-to-cannulate endoscopic retrograde cholangiopancreatography (ERCP) patients.Materials and Methods. Patients with no exclusion criteria and an intact papilla referred for ERCP were invited to participate in the study. “Difficult-to-cannulate” patients, defined as failure to achieve deep biliary cannulation within five minutes from the first touch of papilla, with no more than ten attempts permitted, were randomly assigned for precut sphincterotomy using either the classic NKS or r-ITP.Results. Seventy and 69 patients were randomly assigned to the NKS and r-ITP groups, respectively. The groups were comparable regarding age, sex, indications, and associated conditions. There was no statistically significant difference in terms of successful cannulation or post-ERCP complications between the two groups. Only five patients (3.6%) developed mild to moderate post-ERCP pancreatitis and two had mild bleeding. No perforations or deaths were encountered.Conclusions. Although the round insulated tip papillotome was not shown to be superior to the classic NKS concerning efficacy and safety when used by an experienced endoscopist, it remains a simple, safe, and efficacious alternative.

scholarly journals Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

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.

scholarly journals Difficult Biliary Cannulation for Intradiverticular Papilla: Forceps Technique Revisited

2021 ◽  
Vol 07 (03) ◽  
pp. e191-e194
Author(s):  
Mahesh Kumar Goenka ◽  
Gajanan Ashokrao Rodge ◽  
Bhavik Bharat Shah ◽  
Shivaraj Afzalpurkar
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Biopsy Forceps ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Successful Cannulation ◽  
Difficult Time ◽  
Difficult Biliary Cannulation ◽  
Simultaneous Use

AbstractPeriampullary diverticula (PAD) have been encountered in 5.9 to 18.5% of patients during all the endoscopic retrograde cholangiopancreatography (ERCP). Cannulation in the presence of PAD can sometimes be difficult, time consuming, and often requires a higher level of endoscopic skills.Several techniques have been reported to facilitate and increase the chances of successful bile duct cannulation in the presence of PAD. The two-devices in one-channel method has been sparingly used. It involves the simultaneous use of a biopsy forceps and another instrument, either a cannula or sphincterotome through the same working channel. We successfully performed ERCP in three cases, where bile duct cannulation was performed in the setting of intradiverticular papilla using two-devices in one-channel method.We feel that the two-devices in one-channel method can be very useful and positioned higher up in the algorithm for successful cannulation in patients with PAD.

scholarly journals Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography?

2021 ◽  
Vol 84 (4) ◽  
Author(s):  
R.E. Cankurtaran ◽  
R Atalay ◽  
Y.H. Polat ◽  
F Kivrakoglu ◽  
M Tahtacı ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Common Bile Duct Stones ◽  
Study Patient ◽  
Bile Duct Stones ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Significant Difference ◽  
Difficult Biliary Cannulation

Background and study aim: In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. Patients and methods: Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. Results: 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). Conclusions: The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.

scholarly journals Salvage Techniques for Difficult Biliary Cannulation: A Retrospective Study of 1021 Endoscopic Retrograde Cholangiopancreatography Cases in a Tertiary Referral Center

2021 ◽  
Author(s):  
Shikiko Maruta ◽  
Harutoshi Sugiyama ◽  
Sadahisa Ogasawara ◽  
Chihei Sugihara ◽  
Mayu Ouchi ◽  
...  
Keyword(s):  
Success Rate ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Success Rates ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Tertiary Referral Center ◽  
Treatment Processes ◽  
Difficult Biliary Cannulation ◽  
Needle Knife ◽  
Event Rates

Abstract Although some salvage techniques have been developed to overcome difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP), few reports analyzed the choice of techniques and their clinical outcomes in large cohorts. This study aimed to evaluate the outcomes of biliary cannulation in patients with initial treatment papillae. We retrospectively identified 1021 patients who underwent initial ERCP from January 2013 to March 2020. We investigated background factors, treatment details, success rates, and adverse event rates. Then we analyzed a series of treatment processes, including salvage techniques such as double guidewire technique (DGT), needle knife pre-cutting (NKP), and transpancreatic pre-cut papillotomy (TPPP). The initial ERCP success rate was 94.3%, and the eventual success rate was 98.3%. Salvage techniques were required in 380 of 1021 patients (37.2%), associated with long oral protrusion (OR, 2.38; 95% CI, 1.80–3.15; p < 0.001). A total of 503 cases (49.3%) had long oral protrusions, 47.5% of which required the salvage techniques, much higher than 27.5% of not-long cases. Patients with long oral protrusions had a higher frequency of NKP. In conclusion, patients with long oral protrusions frequently required salvage techniques. Appropriate strategies and salvage techniques may help to overcome many difficult biliary cannulation cases.

scholarly journals Primary needle-knife fistulotomy for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: importance of the endoscopist’s expertise level

2020 ◽  
Author(s):  
Sung Yong Han ◽  
Dong Hoon Baek ◽  
Dong Uk Kim ◽  
Chang Joon Park ◽  
In Sub Han ◽  
...  
Keyword(s):  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Tertiary Referral Center ◽  
Needle Knife ◽  
Expertise Level

Abstract Background Needle-knife fistulotomy (NKF) is used as a rescue technique for difficult cannulation. However, the data are limited regarding the use of needle-knife fistulotomy for primary biliary cannulation, especially when performed by beginners. To assess the effectiveness and safety of primary NKF for biliary cannulation, and the role of the endoscopist’s expertise level (beginner vs. expert). Methods We retrospectively evaluated the records of 613 patients with naïve papilla and no history of pancreatitis, who underwent bile duct cannulation at a tertiary referral center. The patients were categorized according to the endoscopist’s expertise level and the technique used for bile duct cannulation. We assessed the rates of successful cannulation and adverse events. Results The baseline characteristics did not differ between the pre-defined groups. The incidence rate of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) was significantly affected by the endoscopist’s expertise level in patients who received conventional cannulation with sphincterotomy (11.3% vs. 5.7% for beginner vs. expert, P =0.033), but not in those who received NKF. In the multivariable analysis, a lower expertise level of the biliary endoscopist and longer cannulation time were significant risk factor of post-endoscopic retrograde cholangiopancreatography pancreatitis ( P =0.030, P =0.005) in patients who received conventional cannulation with sphincterotomy but not in those who received NKF. Conclusion Compared to conventional cannulation with sphincterotomy, primary NKF carries a lower risk of PEP regardless of the endoscopist’s level of expertise. Primary NKF may be effective and safe in achieving ductal access in patients with naïve papilla.

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

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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