Needle Knife Precut Papillotomy and Fistulotomy for Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography

Digestion ◽  
2013 ◽  
Vol 88 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Qisheng Zhang ◽  
Bing Han ◽  
Jianhua Xu ◽  
Wenmin Bao ◽  
Jieli Tao ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Difficult Biliary Cannulation ◽  
Needle Knife

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 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.

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.

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