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 Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: An Overview of Advanced Techniques

2021 ◽  
pp. 73-82
Author(s):  
Brian M. Fung ◽  
Teodor C. Pitea ◽  
James H. Tabibian
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Success ◽  
Success Rates ◽  
Significant Progress ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Vast Array ◽  
The Past ◽  
Difficult Biliary Cannulation ◽  
Cannulation Success

Endoscopic retrograde cholangiopancreatography (ERCP) plays a significant role in the treatment of a vast array of pancreatobiliary diseases. However, despite significant progress in the optimisation of ERCP methods and accessories, the technical and clinical success of ERCP can vary significantly due to a variety of patient and operator factors. Over the past several decades, a number of advanced techniques have been developed to improve cannulation success rates, including the use of double-guidewire, pancreatic duct accessory-assisted, precut, and rendezvous techniques. Here, the authors provide an update and overview of the existing advanced techniques used in cases of difficult biliary cannulation, as well as the approach to their selection.

scholarly journals DIFFICULT BILIARY CANNULATION: SHOULD WE ALWAYS TRY A SECOND ERCP AFTER A FAILED NEEDLE-KNIFE FISTULOTOMY?

2021 ◽  
Vol 58 (4) ◽  
pp. 509-513
Author(s):  
Victor Kalil FLUMIGNAN ◽  
Marina Garcia SEIKE ◽  
Victória Soares de SOUZA ◽  
Matheus Iguera CIRQUEIRA ◽  
Ana Beatriz SILVA ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Success Rate ◽  
Short Interval ◽  
Normal Position ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Difficult Biliary Cannulation ◽  
Needle Knife ◽  
A Minor

ABSTRACT BACKGROUND: A successful bile duct cannulation is a prerequisite for the realization of endoscopic retrograde cholangiopancreatography (ERCP). When biliary cannulation is not possible, needle-knife fistulotomy (NKF) can be performed. However, when biliary access is not successfully achieved even after performing NKF, it is possible to interrupt the procedure, and repeat the ERCP after a short interval. OBJECTIVE: The aim of this study is to analyze if repeating an ERCP after a short interval of 48 hours is effective in achieving biliary access after an initial NKF was unsuccessfully performed. METHODS: A total of 1024 patients with a naive papilla, that underwent ERCP between the years of 2009-2019, were retrospectively reviewed. Difficult biliary cannulation was identified in 238 of these cases and NKF was performed. Success of biliary cannulation, NKF success at the first and second ERCPs, the associations between the type of the papilla, biliary dilatation, and overall success of NKF and adverse events rates were evaluated. RESULTS: Biliary access was initially achieved in 183 (76.8%) cases. Of the 55 (23.1%) remaining cases a second attempt was performed after 48 hours, and biliary access was successfully achieved in 46 (83.6%) of them. The overall success of NKF after the first and second ERCP, the success rate was 96.2%. Papilla located out of its normal position was related to a minor chance of success at NKF (P<0.05). CONCLUSION: We conclude that when biliary access is not achieved after the performance of a NKF, a second attempt is safe and effective and should be attempted.

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 Utility and safety of a new uneven double-lumen sphincterotome in cases of difficult biliary cannulation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuhei Shintani ◽  
Osamu Inatomi ◽  
Yoshiya Takeda ◽  
Hiroshi Matsumoto ◽  
Takehide Fujimoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Success Rate ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Operation Time ◽  
Conventional Group ◽  
Double Lumen ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Difficult Biliary Cannulation

Abstract Background We investigated the utility and safety of a new uneven double-lumen sphincterotome in biliary cannulation in comparison with the conventional pancreatic guidewire (PGW) method. Methods We retrospectively evaluated 119 patients who required PGW placement because of difficult biliary cannulation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed using a conventional ERCP catheter or a new uneven double-lumen sphincterotome. The success rate of bile duct cannulation, the operation time of bile duct cannulation, and the incidence of post-ERCP pancreatitis (PEP) were evaluated. Results Forty-four patients were treated with a new double-lumen sphincterotome (the new sphincterotome group) and 75 patients underwent conventional PGW placement (the conventional group). The success rate of bile duct cannulation was 39/44 (88.6%) in the new sphincterotome group and 63/75 (84.0%) in the conventional group (not significant). The total biliary cannulation time (from the reach to the papilla to the finish of biliary cannulation) was 16.0 (6.5–78) min in the new sphincterotome group and 26.0 (5–80) min in the conventional group (P < 0.01). The time from PGW placement to bile duct cannulation was 3.5 (0.3–57) min in the magictome group and 12.0 (1–65) min in the conventional group (P < 0.01). Hyperamylasemia was observed in 13/44 (29.5%) and 17/75 (22.7%), respectively (not significant). Five of 44 (11.3%) of the new sphincterotome group and 14/75 (18.7%) of the conventional group were diagnosed with PEP (not significant). Conclusion A new double-lumen sphincterotome allows selective bile duct cannulation to be performed in a shorter time than the conventional PGW method.

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.

scholarly journals Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography: Definitions, Risk Factors, and Implications

2021 ◽  
pp. 64-72
Author(s):  
Brian M. Fung ◽  
Teodor C. Pitea ◽  
James H. Tabibian
Keyword(s):  
Risk Factors ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Significant Progress ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Vast Array ◽  
The Past ◽  
Increased Risk ◽  
Invasive Method ◽  
Difficult Biliary Cannulation

Over the past 50 years, endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred minimally invasive method of treating a vast array of pancreatobiliary diseases. An initial sine qua non for ERCP success is selective ductal cannulation. Despite significant progress in the optimisation of ERCP methods and accessories, selective biliary cannulation using conventional techniques remains unsuccessful in approximately 15% of native papilla cases. Furthermore, difficult biliary cannulation has been associated with an increased risk of post-ERCP pancreatitis, among other adverse events. Here, in the first of a two-part series, the authors provide a primer on standard biliary cannulation techniques and discuss the definition, risk factors, and implications of difficult biliary cannulation. The second part of the series will provide an overview of the existing advanced techniques used in cases of difficult biliary cannulation as well as the approach to their selection.

Sign in / Sign up

Export Citation Format

Share Document