Additional Biliary Cannulation Methods in Patients with Juxtapapillary Duodenal Diverticula

Parlak, Erkan; Köksal, Aydın Şeref; Dışıbeyaz, Selçuk; Çıçek, Bahattin; Uysal, Serkan; Şaşmaz, Nurgül; Şahın, Burhan

doi:10.1007/s10620-012-2246-9

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…ERCP in patients with PAD is not difficult when performed by experienced endoscopists using specialized techniques and devices [7,8]. Endoscopists must be aware of available cannulation techniques in specific conditions of the papilla.…”

Section: Discussionmentioning

confidence: 99%

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla

Lee¹,

Choi²,

Lee³

et al. 2019

Clin Endosc

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Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o'clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

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Section: Discussionmentioning

confidence: 99%

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla

Lee¹,

Choi²,

Lee³

et al. 2019

Clin Endosc

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“…ERCP in patients with PAD is not difficult when performed by experienced endoscopists using specialized techniques and devices. 7,8 Endoscopists must be aware of available cannulation techniques in specific conditions of the papilla. Several techniques have been introduced to facilitate cannulation in the setting of intradiverticular papilla (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…5 Several techniques have been introduced to evert the papillary opening to facilitate cannulation. 1,[6][7][8][9][10][11][12][13][14][15] Submucosal injection, 6 endoscopic clipping, 9 and two-devices-in-one-channel, 10 have been introduced. The submucosal injection method involves lifting of the mucosa to enable eversion and fixing of a papilla in the diverticulum and allows selective cannulation of the biliary tree.…”

Section: Introductionmentioning

confidence: 99%

Papillary Cannulation Facilitated by Submucosal Saline Injection Into the Intradiverticular Papilla

2019

ESGE Days 2019

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Endoscopic retrograde cholangiopancreatography (ERCP) of the intradiverticular papilla with its invisible orifice remains challenging. Several techniques have been introduced to evert the papillary opening to facilitate cannulation. A 79-year-old woman with bile duct stones underwent ERCP, which revealed that the papilla was located inside a large diverticulum and tended to rotate inward with a trial of papillary cannulation. Submucosal papillary injection of 3 cc of normal saline was performed at 3 and 9 o' clock. Eversion and fixation of a papilla in the diverticulum with this technique allowed selective cannulation of the biliary tree. Stones were retrieved after endoscopic papillary balloon dilation without complications. She had an uneventful post-procedural course. Our findings suggest that submucosal saline injection technique is safe and effective for selective cannulation and can be recommended when cannulation is very difficult because of an intradiverticular papilla.

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“… 4 The incidence of PD varies between 0.16 and 31.7% according to the diagnostic method. 5 - 9 When the patient’s age is increased, the diameter and the occurrence of PD also increase. 10 In our series, the incidence of PD was 4.6%, which is less than that recorded in most of the literature.…”

Section: Discussionmentioning

confidence: 99%

Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma

Örmeci

Deda

Kalkan

et al. 2016

Euroasian Journal of Hepato-Gastroenterology

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IntroductionPeriampullary diverticula (PD) is caused by extraluminal pouching of duodenal mucosa. Using a very common endoscopic procedure to diagnose or treat gastrointestinal disorders, we encountered duodenal diverticulum.Materials and methodsThis is a retrospective, single-center study. Three thousand and sixteen patients on whom endoscopic retrograde cholangiopancreatography (ERCP) was performed at Ankara University Medical School, Department of Gastroenterology, from June 2009 to June 2014 were included to the study.ResultsHundred and thirty patients (males 65, females 65) among the 3,016 had PD. Two hundred and sixty patients without diverticulum were randomly chosen from the 3,016 patients, as a control group [121 (47%) females, 139 (53%) males]. There was no statistical difference between the two groups. The mean age of the patients with PD was 69.9 years, while the mean age was 62.3 years for patients without PD (p < 0.001). Incidence for PD was 4.6%. The papilla of Vater was located in the inter-diverticular area (Type 1) in 9 patients (8.3%), at the edge of the diverticulum (Type 2) in 31 patients (28.4%), and at a distance of 2 to 3 cm from the papilla (Type 3) in 69 patients (63.3%).DiscussionAlthough numerically more common bile duct stones occurred in patients with PD compared to those without PD, there was no statistical difference between the two groups. The rate of pancreato-biliary carcinomas was higher in patients without diverticulum. Cannulation was successful in both groups at the rate of 97.6 and 92% respectively, but cannulation failed more often in patients without PD. Duodenal perforation occurred in one patient with PD. Bleeding after sphincterotomy occurred in two patients without PD.How to cite this articleÖrmeci N, Deda X, Kalkan Ç, Tüzün AE, Karakaya F, Dökmeci A, Bahar DK, Özkan H, İdilman R, Çınar K. Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma. Euroasian J Hepato-Gastroenterol 2016;6(1):31-34.

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Additional Biliary Cannulation Methods in Patients with Juxtapapillary Duodenal Diverticula

Abstract: Presence of JPD does not decrease the therapeutic success of ERCP. Placement of a guidewire in the pancreatic duct or use of two-devices-in-one-channel are practical, successful, safe, and preferred methods which can be used in patients with failed cannulation by standard technique.

Cited by 8 publications

References 21 publications

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla

Papillary Cannulation Facilitated by Submucosal Saline Injection into an Intradiverticular Papilla

Papillary Cannulation Facilitated by Submucosal Saline Injection Into the Intradiverticular Papilla

Impact of Periampullary Diverticula on Bile Duct Stones and Ampullary Carcinoma

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