Response:

Abstract

We greatly appreciate Dr Matsushita et al's interest in our novel technique for common bile duct (CBD) access when conventional techniques have failed. Our technique is simple in that it utilizes the Seldinger needle technique and can be employed immediately after failed cannulation. Our technique was first described by Artifon et al1Artifon E.L. Hondo F.Y. Sakai P. et al.A new approach to the bile duct via needle puncture of the papillary roof.Endoscopy. 2005; 37: 1158Crossref PubMed Scopus (8) Google Scholar in 2005 and was then detailed by others.2Artifon E.L. Sakai P. Cardillo G.Z. et al.Suprapapillary needle puncture for common bile duct access: laboratory profile.Arq Gastroenterol. 2006; 43: 299-304Crossref PubMed Scopus (7) Google Scholar, 3Artifon E.L. Sakai P. Ishioka S. et al.Suprapapillary puncture of the common bile duct for selective biliary access: a novel technique (with videos).Gastrointest Endosc. 2007; 65: 124-131Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Dr Matsushita et al suggest accessing the CBD by using endosonography-guided puncture with EUS for conventional cannulation assisted, or not assisted, by fluoroscopy.4Rocca R. De Angelis C. Castellino F. et al.EUS diagnosis and simultaneous endoscopic retrograde cholangiography treatment of common bile duct stones by using an oblique–viewing echoendoscope.Gastrointest Endosc. 2006; 63: 479-483Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar However, subjecting sedated patients in the ERCP position to EUS is logistically challenging and probably impossible at most institutions. In a patient requiring urgent decompression, further delaying the procedure may lead to adverse outcomes. Our technique utilizes a novel catheter that can be used at the same setting and without the need for a separate set up, which is necessary for EUS. Furthermore, although EUS units are becoming increasingly available, they are often housed in locations separate from ERCP units. In our study, there were 5 complications, all minor and not requiring surgical intervention. It is possible that the complication rates would be further reduced by increased experience. While we do not disagree that EUS-guided CBD puncture and cannulation is an option, it is more difficult to undertake at the same setting. We greatly appreciate Dr Matsushita et al's interest in our novel technique for common bile duct (CBD) access when conventional techniques have failed. Our technique is simple in that it utilizes the Seldinger needle technique and can be employed immediately after failed cannulation. Our technique was first described by Artifon et al1Artifon E.L. Hondo F.Y. Sakai P. et al.A new approach to the bile duct via needle puncture of the papillary roof.Endoscopy. 2005; 37: 1158Crossref PubMed Scopus (8) Google Scholar in 2005 and was then detailed by others.2Artifon E.L. Sakai P. Cardillo G.Z. et al.Suprapapillary needle puncture for common bile duct access: laboratory profile.Arq Gastroenterol. 2006; 43: 299-304Crossref PubMed Scopus (7) Google Scholar, 3Artifon E.L. Sakai P. Ishioka S. et al.Suprapapillary puncture of the common bile duct for selective biliary access: a novel technique (with videos).Gastrointest Endosc. 2007; 65: 124-131Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Dr Matsushita et al suggest accessing the CBD by using endosonography-guided puncture with EUS for conventional cannulation assisted, or not assisted, by fluoroscopy.4Rocca R. De Angelis C. Castellino F. et al.EUS diagnosis and simultaneous endoscopic retrograde cholangiography treatment of common bile duct stones by using an oblique–viewing echoendoscope.Gastrointest Endosc. 2006; 63: 479-483Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar However, subjecting sedated patients in the ERCP position to EUS is logistically challenging and probably impossible at most institutions. In a patient requiring urgent decompression, further delaying the procedure may lead to adverse outcomes. Our technique utilizes a novel catheter that can be used at the same setting and without the need for a separate set up, which is necessary for EUS. Furthermore, although EUS units are becoming increasingly available, they are often housed in locations separate from ERCP units. In our study, there were 5 complications, all minor and not requiring surgical intervention. It is possible that the complication rates would be further reduced by increased experience. While we do not disagree that EUS-guided CBD puncture and cannulation is an option, it is more difficult to undertake at the same setting. EUS-guided suprapapillary puncture for safe selective biliary accessGastrointestinal EndoscopyVol. 66Issue 4PreviewTo the Editor: Full-Text PDF