Biliary Cannulation In Endoscopic Retrograde Cholangiopancreatography Research Articles

How to take advantage of a failed precut to achieve biliary cannulation in ERCP.

After nearly 50 years of therapeutic endoscopic retrograde cholangio-pancreatography (ERCP), deep cannulation of the desired duct, whether biliary or pancreatic, remains primarily an art. Most ERCP procedures are performed for biliary drainage.

Risk factors of selective biliary cannulation in endoscopic retrograde cholangiopancreatography for choledocholithiasis and the value of assistant cannulation methods

Objective To investigate the risk factors of standard selectivity biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) for patints with choledocholithiasis, and the effect and safety of assistant cannulation methods. Methods The clinical data were retrospectively analyzed in 372 patients, who received ERCP for choledocholithiasis in the Yijishan Hospital of Wannan Medical College from January 2014 to December 2014. The risk factors of standard biliary cannulation were assessed by univariate and multivariate logistic regression analysis. The success rate of assistant biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) of standard biliary cannulation were compared with double-guide wire technique (DGT) and precut sphincterotomy (PS), which were used when standard biliary cannulation failed. Results The univariate analysis showed that floppy and long duodenal papilla(P=0.000), angulated common bile duct(P=0.013) were related to failure of standard biliary cannulation.Multivariate analysis showed that floppy and long papilla (P=0.000, OR=0.131, 95%CI: 0.056-0.307), angulated common bile duct (P=0.003, OR=0.378, 95%CI: 0.197-0.726) were independent risk factors for standard biliary cannulation. The success rate of standard biliary cannulation was 83.3% (310/372), 62 cases undergone DGT or PS after standard biliary cannulation failure, and the total success rate of cannulation was 99.7% (371/372). There were 29 cases suffered from PEP in 371 successful cases of biliary cannulation, including 18 cases (5.8%, 18/310) of standard biliary cannulation, 8 cases (16.3%, 8/49) of DGT, and 3 cases (25.0%, 3/12) of PS. The incidence of PEP by DGT (χ2=5.532, P=0.019) and PS (χ2=6.994, P=0.008) was significantly higher than that of standard biliary cannulation, but there was no statistical difference on the incidence of PEP between DGT and PS (χ2=0.079, P=0.778). Conclusion Floppy and long duodenal papilla and angulated common bile duct could easily induce the failure of standard biliary cannulation in ERCP for patients with choledocholithiasis. DGT and PS are effective assistant cannulation methods when the standard cannulation fails. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Intubation; Risk factors; Safety

Angled- or straight-tipped hydrophilic guidewire in biliary cannulation: a prospective, randomized, controlled trial

Deep biliary cannulation is the key for successful endoscopic retrograde cholangiopancreatography (ERCP) procedures. Guidewire-assisted cannulation is associated both with a higher success rate and a reduced risk of post-ERCP pancreatitis compared with standard catheter cannulation. However, to our knowledge there are no prospective, randomized studies comparing the use of different guidewires in biliary cannulation. The goal of this study was to compare the performance of an angled-tipped guidewire (AGW) with a straight-tipped guidewire (SGW) in achieving successful deep biliary cannulation. Patients with intended biliary cannulation of an intact papilla were prospectively randomized to angled- or straight-tipped hydrophilic guidewire arms in a tertiary, referral, university hospital setting. Randomized cannulation method was applied either until successful cannulation of the bile duct or until 2 min had passed. Crossover was not included in the study protocol. The main outcome measurements were the cannulation success rate and duration of cannulation. Of the 239 consecutive patients, 155 patients were randomized: in the final analysis 70 patients were included in the AGW arm and 83 patients in the SGW arm. Cannulation time [median; seconds (s)] was shorter with the AGW compared with the SGW (20 vs. 63 s, p = 0.01). There was no difference in the cannulation success rate or the complication rate between the two study groups. AGW may facilitate biliary cannulation in ERCP.

Endoscopic precut sphincterotomy for cannulation of inaccessible common bile duct： transpancreatic septum precut versus needle-knife

Objective To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography （ERCP）. Methods Data of 109 patients with difficult biliary cannulation in ERCP, of whom 56 underwent transpancreatic septum precut and 53 had needle-knife sphincterotomy from January 2006 to July 2008, were analyzed retrospectively, and the success rate of cannulation and the occurrence of complications were compared between the two methods. Results Of 109 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 97. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 96. 4% （54/56） and 81.1% （43/53） respectively, which was significantly different （ P 〈 0.05 ）. Complications occurred in 11 cases, including bleeding（ n = 4）, acute pancreatitis （ n = 5 ）, cholangitis（n = 2 ）. The tolal frequency of complications of the transpancreatic septum pre-cut papillotomy group was lower than that of needle-knife sphincterotomy group（3.6% vs. 17. 0% , P 〈 0. 05 ）. Conclusion In patients with inaccessible bile ducts, transpancreatic septum precut is a safe and effective procedure in cannulation, exhibiting a higher success rate and lower occurrence of complication when compared with needleknife sphincterotomy. Key words: Cholangiopancreatography, endoscopic retrograde ; Common bile duct ; Precut ; Septnm ; Postoperative complications

Needle-knife assisted ERCP

During endoscopic retrograde cholangiopancreatography (ERCP), incising through the wall of the major papilla with an electrocautery needle-knife is a method for achieving access into the bile duct. This procedure, often referred to as a "precut," may be used when cannulation attempts via the orifice of the papilla are unsuccessful. Potential complications include hemorrhage, duodenal perforation, and acute pancreatitis. The 172 patients who underwent an attempt of a needle-knife assisted ERCP during the years 1997-2003 at our institution were retrospectively evaluated. A selective bile duct cannulation was achieved after needle-knife incision in 148 out of 172 patients (86%) at the primary session. In 10 additional patients (6%), a repeated procedure proved successful for cannulation. In the remaining 14 patients (8%), the biliary cannulation failed and was not attempted again. Complications after needle-knife assisted ERCP occurred as follows: three patients (2%) presented with late bleeding after the ERCP and three patients (2%) developed acute pancreatitis. None of the patients required operative treatment for complications. There was no mortality. The use of the needle-knife markedly improves the success rate of selective biliary cannulation in ERCP without increasing the rate of complications.