Sa1505 Needle-Knife Precut Sphincterotomy With a Small Incision Made Possible by Prior Pancreatic Stent Placement Reduces the Complication Rate in Difficult Biliary Cannulation

Abstract

classified as a figure ‘V’ type in 208 patients with sharp angles between Ab with Ac, while classified as a figure ‘T’ type in 162 patients with right angle, and as a ‘Septal’ type in 39 patients in whom Ac was extremely short. 16 patients showed anomaly arrangement of pancreatico-biliary duct. Results: Classified by the orifice morphology, 307 patients were L/N in Mono group and 151 patients were D in Dual group (p 0.01). L/N would have Mono orifice, which has various bifurcations (OR 10.0). The patients with intra-papillary choledochocele were confirmed in 31 patients only in L/N. The numbers of patients who required MPD/GW assist in this study were 144 with L/N and 47 with D (p 0.01). The incidence of post ERCP pancreatitis (PEP) was 3.6% with L/N and 1.6% with D (p 0.25). Conclusion: Wire Guided Cannulation is popular in performing ERCP recently. However, it’s superiority by Radomized Controlled Studies has still proved controversial. Everyone agrees visible cannulation would promise to make sure the treatment. The reason why there are unexpected variations known for IPB such as figure ‘T’ and choledochocele especially with L/N. If Vater’s ampula would be recognized L/N, a minimal dose injection is recommended in order to visualize the intra-papillary anatomy. That allows achieving a safe and reliable ERCP to avoid PEP.