A new method for deep cannulation of the bile duct by straightening the pancreatic duct

Gotoh, Yasuhiko; Tamada, Kiichi; Tomiyama, Takeshi; Wada, Shinichi; Ohashi, Akiyoshi; Satoh, Yasuyuki; Higashizawa, Toshihiko; Miyata, Takamitsu; Ido, Kenichi; Sugano, Kentaro

doi:10.1067/mge.2001.113387

Cited by 36 publications

(35 citation statements)

References 8 publications

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“…Dumonceau et al [4] first reported P-GW for selective biliary cannulation in a patient with surgically altered anatomy. Gotoh et al repor ted a second case of successful biliary cannulation with P-GW in a patient with a tortuous common channel [5] . P-GW ser ves several functions advantageous for selective bile duct cannulation, including opening a stenotic papillary orifice, stabilizing the papilla and lifting it up towards the working channel, straightening the pancreatic duct and the common channel, draining the pancreatic duct, potentially minimizing repeated injections into the pancreatic duct, and providing access for placement of a pancreatic stent if necessary [2] .…”

Section: Discussionmentioning

confidence: 99%

“…Numerous techniques have been developed for selective biliary cannulation [2,3] . Pancreatic guidewire placement (P-GW) has been reported to be effective in patients with difficult cannulation of the bile duct [4][5][6][7] . Since P-GW is usually attempted in patients with difficult cannulation of the bile duct, this technique entails a possible increased risk of post-ERCP pancreatitis.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography

Ito¹,

Fujita²,

Noda³

et al. 2008

WJG

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CONCLUSION: P-GW is useful for achieving selective biliary cannulation. Pancreatic duct stenting after P-GW can reduce the incidence of post-ERCP pancreatitis, which requires evaluation by means of prospective randomized controlled trials. INTRODUCTIONEndoscopic retrograde cholangio-pancreatography (ERCP), which was first reported in the late 1960's [1] , is a well-accepted technique for evaluating pancreatobiliary diseases. Although selective cannulation of the bile duct is mandatory for therapeutic ERCP of biliary diseases, anatomical difficulties or papillary spasm sometimes preclude it. Numerous techniques have been developed for selective biliary cannulation [2,3] . Pancreatic guidewire placement (P-GW) has been reported to be effective in patients with difficult cannulation of the bile duct [4][5][6][7] . Since P-GW is usually attempted in patients with difficult cannulation of the bile duct, this technique entails a possible increased risk of post-ERCP pancreatitis. The aim of this study was to investigate the frequency and risk factors for acute pancreatitis after P-GW in achieving cannulation of the bile duct during ERCP. Abstract AIM: To investigate the frequency and risk factors for acute pancreatitis after pancreatic guidewire placement (P-GW) in achieving cannulation of the bile duct during endoscopic retrograde cholangio-pancreatography (ERCP). METHODS: P-GW was performed in 113 patients in whom cannulation of the bile duct was difficult. The success rate of biliary cannulation, the frequency and risk factors of post-ERCP pancreatitis, and the frequency of spontaneous migration of the pancreatic duct stent were investigated. RESULTS: Selective biliary cannulation with P-GW was achieved in 73% of the patients. Post-ERCP pancreatitis occurred in 12% (14 patients: mild, 13; moderate, 1). Prophylactic pancreatic stenting was attempted in 59% of the patients. Of the 64 patients who successfully underwent stent placement, three developed mild pancreatitis (4.7%). Of the 49 patients without stent placement, 11 developed pancreatitis (22%: mild, 10; moderate, 1). Of the five patients in whom stent placement was unsuccessful, two developed mild pancreatitis. Univariate and multivariate analyses revealed no pancreatic stenting to be the only significant risk factor for pancreatitis. Spontaneous migration of the stent was observed within two weeks in 92% of the patients who had undergone pancreatic duct stenting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography

Ito¹,

Fujita²,

Noda³

et al. 2008

WJG

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“…Since its first description [2], the adoption of this technique has improved the success rate of biliary cannulation for cases in which the guidewire passes repeatedly into the pancreatic duct. The literature contains some case reports [2,3], some case series [4][5][6], and two prospective randomized trials [7,8] on the role of the double-guidewire technique in difficult biliary cannulation.…”

mentioning

confidence: 99%

Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center

et al. 2010

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“…P-GW for selective biliary cannulation in a patient with surgically altered anatomy was first reported by Dumonceau et al [17] . Gotoh et al [18] reported a second case of successful biliary cannulation with P-GW in a patient with a tortuous common channel. The method which was subsequently employed by Maeda et al [19] and Ito et al [20] in a substantial number of cases is reported to increase the bile duct cannulation rate in selective bile duct difficult cannulation cases by reducing, linearizing and fixing the sphincter muscle of papilla, and is useful in cases with parapapillary diverticulum, deviated papilla and with strong papillary mobility, and those with a tortuous and long papillary sphincter muscle.…”

Section: B Amentioning

confidence: 99%

“…ed cannulation [15,16] , pancreatic duct guidewire-indwelling method (P-GW) [1,[17][18][19][20] , etc. From the empirical viewpoint, the endoscopic approach to the pancreatic duct is easier and causes less difficulty in cannulation in comparison with that to the bile duct.…”

Section: Case Reportmentioning

confidence: 99%

New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

Sakai

Ishihara²,

Tsuyuguchi³

et al. 2011

WJGE

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The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis. Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice, endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus. Pancreatogram was slightly and insufficiently obtained by injecting the contrast media via the common channel of the duodenal main papilla. We tried to cannulate selectively into the pancreatic duct for a clear image. However, the selective cannulation of the pancreatic duct was difficult because of instability of the papilla. On the other hand, selective cannulation of the bile duct was relatively easily achieved. Therefore, after the imaging of the bile duct, a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted. As a result, selective pancreatic duct cannulation became possible. It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is difficult ("selective pancreatic duct difficult cannulation case").

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A new method for deep cannulation of the bile duct by straightening the pancreatic duct

Cited by 36 publications

References 8 publications

Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography

Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography

Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center

New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

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