Biliary Sphincterotomy Techniques

2009 ◽  
pp. 319-327
Author(s):  
Gianpiero Manes
Keyword(s):  
Biliary Sphincterotomy

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

Endoscopy ◽  
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.

scholarly journals Sphincter of Oddi Dysfunction: A Perplexing Presentation

2016 ◽  
Vol 10 (3) ◽  
pp. 714-719 ◽  
Author(s):  
Sana Ahmad Din ◽  
Iman Naimi ◽  
Mirza Beg
Keyword(s):  
Abdominal Pain ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Sphincter Of Oddi ◽  
Abdominal Ultrasound ◽  
Sphincter Of Oddi Dysfunction ◽  
Sphincter Pressure ◽  
Abdominal Symptoms ◽  
Biliary Sphincterotomy ◽  
Bile Drainage ◽  
Oddi Dysfunction

Sphincter of Oddi dysfunction is caused by stenosis or dyskinesia of the sphincter of Oddi, leading to blockage of bile drainage from the common bile duct. We present the case of a 16-year-old female with chronic abdominal pain who underwent laparoscopic cholecystectomy for cholelithiasis but continued to experience abdominal pain, nausea, and vomiting along with persistently elevated ALT and AST levels. Postoperative abdominal ultrasound was nondiagnostic. Esophagogastroduodenoscopy showed mild reflux esophagitis and mild chronic Helicobacter pylori-negative gastritis. Omeprazole was started, but it did not decrease the frequency and severity of the abdominal symptoms. Magnetic resonance cholangiopancreatography did not reveal any pathology. Endoscopic retrograde cholangiopancreatography with manometry confirmed an elevated biliary sphincter pressure. Biliary sphincterotomy was performed, and the symptoms improved.

scholarly journals Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques

Medicina ◽  
2022 ◽  
Vol 58 (1) ◽  
pp. 120
Author(s):  
Edoardo Troncone ◽  
Michelangela Mossa ◽  
Pasquale De Vico ◽  
Giovanni Monteleone ◽  
Giovanna Del Vecchio Blanco
Keyword(s):  
Balloon Dilation ◽  
Common Bile Duct Stones ◽  
Endoscopic Management ◽  
Stone Extraction ◽  
Biliary Stones ◽  
Electrohydraulic Lithotripsy ◽  
Biliary Sphincterotomy ◽  
Single Operator ◽  
Large Balloon ◽  
Large Balloon Dilation

Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.

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