Abstract
Electrocoagulation is used for opening the biliary duct in alternative procedures aiming at deep cannulation of the CBD and it seems to be the source of some complications. The dissection of the biliary duct in the papilla allows this duct to be opened by a sharp instrument or forceps without the use of electrocoagulation.This study deals with this different endoscopic access to the CBD. Methods - From January 1993 to December 1998, 1081 patients were referred to ERCP. In 24 of these patients, cannulation was not attempted or deep cannulation was not successful either because the papilla could not be reached or because it showed benign or malignant alterations. In the remaining 1057 patients, cannulation was attempted. The standard deep cannulation of the common bile duct (CBD) was achieved in 1008 (95.36%) and failed in 49 patients. From this latter group, 48 patients underwent an alternative procedure aimed at achieving deep cannulation: endoscopic dissection of the distal biliary duct. In four of them the opening was achieved without electrocoagulation: in two of these cases, a needle was used; in the other two, a forceps. Results - No complications of ERCP occurred in the postoperative course. Cholangiography having revealed choledocholithiasis in three patients, papillotomy and clearance of CBD complemented the procedure. In only one patient the amilasemia level was determined and found normal. The other patient had a normal X-ray image. Conclusion - The endoscopic dissection of the biliary duct in the major duodenal papilla is a procedure performed under visual control and permits to open the duct with mechanical maneuvers. The fact that no electrocoagulation is used can avoid some complications like pancreatitis.Opening the biliary duct in the major papilla without electrocoagulation can be the best option for cholangiography when an alternative procedure is required to achieve deep cannulation of the CBD.
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