Abstract
BackgroundDifficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can result in failure of common bile duct (CBD) stone removal and pancreatitis. The present study aimed to report the efficacy and safety of limited precut sphincterotomy (PS) combined with endoscopic papillary balloon dilation (EPBD) for CBD stone removal in patients with difficult biliary cannulation, and the complications associated with this combined procedure.MethodsA total of 3305 patients underwent ERCP in our hospital between October 2009 and September 2014 and 258 were diagnosed with difficult biliary cannulation. Of these 258 patients, 58 underwent limited PS combined with EPBD for CBD stone removal, and these 58 patients were included in this retrospective study.ResultsThe overall success rate was 94.8 % (55/58), and the success rate for single-session removal was 87.9 % (51/58). The mean procedure time was 41 ± 11.48 min (range, 20–72 min). Mechanical lithotripsy was needed in 10.3 % (6/58) of patients. Procedure-related complications included bleeding in 3.4 % (2/58), pancreatitis in 8.6 % (5/58) and biliary tract infection (BTI) in 1.7 % (1/58) of patients.ConclusionsThe therapeutic outcome of limited PS combined with EPBD for CBD stone removal in patients with difficult biliary cannulation was good with an acceptable complication rate. It could be an alternative to PS and “early” limited PS should be used for prompt identification of the bile duct. Limited PS combined with EPBD is safe and effective for CBD stone removal in patients with difficult biliary cannulation.
Highlights
Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can result in failure of common bile duct (CBD) stone removal and pancreatitis
A common bile duct (CBD) stone complicated with cholangitis, obstructive jaundice, or pancreatitis is a common disease of the biliary tract
For those who received anticoagulant for secondary prevention in low cardiovascular risk patients, we stopped clopidogrel, Fig. 1 a Difficult biliary cannulation was due to failure of 10 attempts at duodenal papilla; (b) Limited precut sphincterotomy was performed with the extent of cutting was less than half the length of the papillary mound; (c) Common bile duct stone was found after successful biliary cannulation; (d) Endoscopic papillary balloon dilation was performed after limited precut sphincterotomy; (e and f) Common bile duct stone was extracted by retrieval balloon prasugrel, ticagrelor and coumadin 5 days before ERCP according to British Society of Gastroenterology and European Society of Gastrointestinal endoscopy [14, 15]
Summary
Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) can result in failure of common bile duct (CBD) stone removal and pancreatitis. The present study aimed to report the efficacy and safety of limited precut sphincterotomy (PS) combined with endoscopic papillary balloon dilation (EPBD) for CBD stone removal in patients with difficult biliary cannulation, and the complications associated with this combined procedure. A common bile duct (CBD) stone complicated with cholangitis, obstructive jaundice, or pancreatitis is a common disease of the biliary tract. Gaining access to the CBD is the most importance step for successful therapeutic endoscopic retrograde cholangiopancreatography (ERCP) [1,2,3,4,5,6,7]. Difficult biliary cannulation is defined as a situation in which an endoscopist, using the regular cannulation technique, fails
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