Euroasian journal of hepato-gastroenterology

Register      Login

VOLUME 14 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Combination of Precut Techniques in Difficult Biliary Cannulation

Azar Abiyev, Barış Tuzcu, Gülden Bilican, Harun Küçük, Serkan Dumanlı, Seçkin Özgül, Mustafa Ergin, Güner Kılıç, Ali Karataş, Murat Kekilli

Keywords : Difficult biliary cannulation, Needle-knife sphincterotomy, Transpancreatic septotomy

Citation Information : Abiyev A, Tuzcu B, Bilican G, Küçük H, Dumanlı S, Özgül S, Ergin M, Kılıç G, Karataş A, Kekilli M. Combination of Precut Techniques in Difficult Biliary Cannulation. Euroasian J Hepatogastroenterol 2024; 14 (1):56-59.

DOI: 10.5005/jp-journals-10018-1428

License: CC BY-NC 4.0

Published Online: 12-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Selective biliary cannulation (SBC) is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP). SBC has the potential to fail in as many as 20% of cases, even with skilled endoscopists. Precut incision techniques like needle-knife sphincterotomy (NKS) and transpancreatic septotomy (TPS) can be used in cases where standard cannulation techniques fail. However, these precut techniques may also fail in some cases. We aimed to evaluate the procedural success of the combined TPS + NKS technique in difficult biliary cannulation. Patients and methods: The study included 289 patients who underwent ERCP with precut techniques from 2017 to 2022. Patients were classified into the following three groups and evaluated retrospectively in terms of cannulation success, and ERCP-related adverse effects: Transpancreatic septotomy, NKS, and TPS + NKS; statistical package for the social sciences (SPSS), version 29.0, software was used to analyze the data. Results: The success rate of SBC was 69% in the TPS group, 75.3% in the NCS group, and 87% in the TPS + NCS group. There was no significant difference between the NKS and TPS + NKS groups. Cannulation success in both NKS group and NKS + TPS groups was significantly higher than in the TPS group (p < 0.001). Complication rates were similar. Conclusion: In cases where standard sphincterotomy and precut techniques fail, a second precut technique can be used. A previous TPS does not prevent NKS.


PDF Share
  1. Testoni PA, Mariani A, Aabakken L, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016;48(7):657–683. DOI: 10.1055/s-0042-108641.
  2. de-la-Morena-Madrigal EJ. Impact of combined precut techniques on selective biliary cannulation. Rev Esp Enferm Dig 2013;105(6):338–344. DOI: 10.4321/s1130-01082013000600005.
  3. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2020;52(2):127–149. DOI: 10.1055/a-1075-4080.
  4. Chandrasekhara V, Khashab MA, Muthusamy VR, et al. Adverse events associated with ERCP. Gastrointest Endosc 2017;85(1):32–47. DOI: 10.1016/j.gie.2016.06.051.
  5. Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: Management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci 2018;25(1):96–100. DOI: 10.1002/jhbp.519.
  6. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: An attempt at consensus. Gastrointest Endosc 1991;37(3):383–393. DOI: 10.1016/s0016-5107(91)70740-2.
  7. Tse F, Yuan Y, Moayyedi P, et al. Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Cochrane Database Syst Rev 2012;12(12):CD009662. DOI: 10.1002/14651858.CD009662.pub2.
  8. Williams EJ, Taylor S, Fairclough P, et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio–pancreatograph practice. Gut 2007;56(6):821–829. DOI: 10.1136/gut.2006.097543.
  9. Berry R, Han JY, Tabibian JH. Difficult biliary cannulation: Historical perspective, practical updates, and guide for the endoscopist. World J Gastrointest Endosc 2019;11(1):5–21. DOI: 10.4253/wjge. v11.i1.5.
  10. Weber A, Roesch T, Pointner S, et al. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: A safe and successful technique. Pancreas 2008;36(2):187–191. DOI: 10.1097/MPA.0b013e31815ac54c.
  11. Harewood GC, Baron TH. An assessment of the learning curve for precut biliary sphincterotomy. Am J Gastroenterol 2002;97(7): 1708–1712. DOI: 10.1111/j.1572-0241.2002.05829.x.
  12. Halttunen J, Keränen I, Udd M, et al. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 2009;23(4):745–749. DOI: 10.1007/s00464-008-0056-0.
  13. Robison LS, Varadarajulu S, Wilcox CM. Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise? World J Gastroenterol 2007;13(15):2183–2186. DOI: 10.3748/wjg.v13.i15. 2183.
  14. Espinel–Díez J, Pinedo–Ramos E, Vaquero–Ayala L, et al. Combined precut in difficult biliary cannulation. Rev Esp Enferm Dig 2013;105(6):334–337. DOI: 10.4321/s1130-01082013000600004.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.