Gut Liver.  2015 Jul;9(4):534-539. 10.5009/gnl14223.

Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation

• Lee YJ
• Park YK
• Lee MJ
• Lee KT
• Lee KH
• Lee JK

• KMID: 2160638
• DOI: http://doi.org/10.5009/gnl14223

Abstract

BACKGROUND/AIMS
Several precut techniques have been used to gain biliary access for difficult cases. The aim of this study was to evaluate the success and complication rates of two precut techniques, transpancreatic septotomy (TPS) and needle knife infundibulotomy (NKI), in difficult biliary cannulation due to the presence of unintended pancreatic cannulation.
METHODS
Eighty-six patients who failed standard biliary cannulation were included. TPS was performed when we failed to achieve biliary access despite 5 minutes of attempted cannulation or when more than three attempted unintended pancreatic cannulations occurred. If deep cannulation was not achieved within 5 minutes for any duct, NKI was performed. If this failed, we crossed over to the other technique in the second attempt.
RESULTS
The initial total success rate of biliary cannulation was 88.4% (86.6% for the TPS group and 94.7% for the NKI group, p=0.447). After crossover of the techniques, the final success rate was 95.3%. The complication rate was 20.9% in patients with TPS and 15.8% in patients with NKI (p=0.753).
CONCLUSIONS
The use of different strategies based on the presence of unintended pancreatic cannulation may help increase the success rate for difficult biliary cannulation without increasing complication rates.

Keyword

Difficult biliary cannulation; Cholangiopancreatography, endoscopic retrograde; Needle knife infundibulotomy; Transpancreatic septotomy

MeSH Terms

Aged
Bile Ducts/surgery
Biliary Tract Diseases/*surgery
Catheterization/adverse effects/instrumentation/*methods
Cholangiopancreatography, Endoscopic Retrograde/adverse effects/*methods
Female
Humans
Male
Middle Aged
Pancreas/surgery
Prospective Studies
Retrospective Studies
Sphincterotomy, Endoscopic/adverse effects/instrumentation/*methods
Surgical Instruments
Treatment Outcome