Goals: To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques. Background: Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cann...Goals: To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques. Background: Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cannulation techniques fail. Little comparative data exist on the outcome of precut NKS. Study: Retrospective comparison of outcome differences of three NKS techniques performed by three pancreaticobiliary endoscopists at a tertiary referral center. Results: A total of 139 consecutive biliary NKS were performed. In 44 cases (technique A), NKS was performed using a precut fistulotomy technique avoiding the papillary orifice, with pure cutting current, and occasional pancreatic duct (PD) stenting (6 of 44). In 47 cases (technique B), NKS was performed starting from the papillary orifice cutting upward with blended current, and no PD stenting. In 48 cases (technique C), NKS was performed as B but using pure cutting current and frequent PD stenting (15 of 48).NKS was successful in 95.5% ,95.7% , and 89.6% at initial endoscopic retrograde cholangiopancreatography and 100% , 97.8% , and 95.6% after a second endoscopic retrograde cholangiopancreatography. Total complications were not significantly different between the three groups; however, a lower incidence of pancreatitis occurred using technique A compared with techniques B and C (not significant). Conclusions: NKS techniques result in a high success rate of biliary cannulation with a similar overall complication rate. Avoiding cutting at the papillary orifice may reduce the risk of pancreatitis. When cutting at the papillary orifice, pancreatic duct stenting, pure cutting current, or both may reduce the incidence of pancreatitis.展开更多
Background:Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope,which is then used for over-the-wire cannulation.The wire is time c...Background:Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope,which is then used for over-the-wire cannulation.The wire is time consuming to maneuver and may be damaged during withdrawal.Objective:Description of a simple technique for cannulation at rendezvous that overcomes these problems.Design:Observational study.Setting:Gastroenterology department of a teaching district general hospital.Patients:Fourteen consecutive patients undergoing rendezvous after percutaneous transhepatic cholangiography(PTC).Intervention:A transpapillary drain was placed at PTC in 13 patients.At rendezvous,cannulation alongside the drain was attempted with a sphincterotome cannula.After successful cannulation,the drain was progressively withdrawn,allowing retrograde therapeutic intervention.Results:In all 13 patients,parallel cannulation was successful,allowing stone removal or biliary stent placement,with cannulation alongside a guidewire in the fourteenth patient.There were no complications except right hypochondrial pain after drain removal.Conclusions:Parallel cannulation is straight forward and effective,avoiding the need for guidewire manipulation.展开更多
文摘Goals: To assess the outcome differences following different precut biliary sphincterotomy needle-knife techniques. Background: Precut biliary needle-knife sphincterotomy (NKS) allows biliary access when standard cannulation techniques fail. Little comparative data exist on the outcome of precut NKS. Study: Retrospective comparison of outcome differences of three NKS techniques performed by three pancreaticobiliary endoscopists at a tertiary referral center. Results: A total of 139 consecutive biliary NKS were performed. In 44 cases (technique A), NKS was performed using a precut fistulotomy technique avoiding the papillary orifice, with pure cutting current, and occasional pancreatic duct (PD) stenting (6 of 44). In 47 cases (technique B), NKS was performed starting from the papillary orifice cutting upward with blended current, and no PD stenting. In 48 cases (technique C), NKS was performed as B but using pure cutting current and frequent PD stenting (15 of 48).NKS was successful in 95.5% ,95.7% , and 89.6% at initial endoscopic retrograde cholangiopancreatography and 100% , 97.8% , and 95.6% after a second endoscopic retrograde cholangiopancreatography. Total complications were not significantly different between the three groups; however, a lower incidence of pancreatitis occurred using technique A compared with techniques B and C (not significant). Conclusions: NKS techniques result in a high success rate of biliary cannulation with a similar overall complication rate. Avoiding cutting at the papillary orifice may reduce the risk of pancreatitis. When cutting at the papillary orifice, pancreatic duct stenting, pure cutting current, or both may reduce the incidence of pancreatitis.
文摘Background:Biliary access at ERCP rendezvous is usually achieved by withdrawing a wire passed antegrade via the accessory channel of the duodenoscope,which is then used for over-the-wire cannulation.The wire is time consuming to maneuver and may be damaged during withdrawal.Objective:Description of a simple technique for cannulation at rendezvous that overcomes these problems.Design:Observational study.Setting:Gastroenterology department of a teaching district general hospital.Patients:Fourteen consecutive patients undergoing rendezvous after percutaneous transhepatic cholangiography(PTC).Intervention:A transpapillary drain was placed at PTC in 13 patients.At rendezvous,cannulation alongside the drain was attempted with a sphincterotome cannula.After successful cannulation,the drain was progressively withdrawn,allowing retrograde therapeutic intervention.Results:In all 13 patients,parallel cannulation was successful,allowing stone removal or biliary stent placement,with cannulation alongside a guidewire in the fourteenth patient.There were no complications except right hypochondrial pain after drain removal.Conclusions:Parallel cannulation is straight forward and effective,avoiding the need for guidewire manipulation.
