Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy (with video) - 22/08/11
Reprint requests: Riad Azar, MD, Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110.St. Louis, Missouri, Boston, Massachusetts, USA
Abstract |
Background |
Successful cannulation of the common bile duct (CBD) remains the benchmark for ERCP. Use of a pancreatic duct (PD) stent to facilitate biliary cannulation has been described, although the majority of patients require precut sphincterotomy to achieve CBD cannulation.
Objective |
To report the performance characteristics of using a PD stent in conjunction with physician-controlled wire-guided cannulation (WGC) to facilitate bile duct cannulation.
Design |
Retrospective cohort.
Setting |
Two tertiary care, academic medical centers.
Patients |
All undergoing ERCP with native papillae.
Intervention |
In cases of difficult biliary access in which the PD is cannulated, a pancreatic stent is placed. After this, physician-controlled WGC is attempted by using the PD stent to direct the sphincterotome into the biliary orifice. If cannulation is unsuccessful after several minutes, a precut sphincterotomy is performed over the PD stent or the procedure is terminated.
Main Outcome Measurements |
Frequency of successful bile duct cannulation and precut sphincterotomy.
Results |
A total of 2345 ERCPs were identified, 1544 with native papillae. Among these, CBD and PD cannulation failed in 16 (1.0%) patients, whereas 76 (4.9%) patients received a PD stent to facilitate biliary cannulation. Successful cannulation was achieved in 71 (93.4%) of 76 patients, 60 (78.9%) of whom did not require precut sphincterotomy. Complications included mild post-ERCP pancreatitis in 4 (5.3%) and aspiration in 1 (1.3%). Precut sphincterotomy was complicated by hemorrhage, controlled during the procedure in 2 (13.3%) of 15.
Conclusions |
Physician-controlled WGC over a PD stent facilitates biliary cannulation while maintaining a low rate of precut sphincterotomy.
Le texte complet de cet article est disponible en PDF.Abbreviations : CBD, PD, WGC
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
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| If you would like to chat with an author of this article, you may contact Dr. Coté at gcote@iupui.edu. |
Vol 71 - N° 2
P. 275-279 - février 2010 Retour au numéro
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