Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation

Abstract

Background/AimsSeveral precut techniques have been used to gain biliary access for difficult cases. The aim of this study was to evaluate the success and complication rates of two precut techniques, transpancreatic septotomy (TPS) and needle knife infundibulotomy (NKI), in difficult biliary cannulation due to the presence of unintended pancreatic cannulation.MethodsEighty-six patients who failed standard biliary cannulation were included. TPS was performed when we failed to achieve biliary access despite 5 minutes of attempted cannulation or when more than three attempted unintended pancreatic cannulations occurred. If deep cannulation was not achieved within 5 minutes for any duct, NKI was performed. If this failed, we crossed over to the other technique in the second attempt.ResultsThe initial total success rate of biliary cannulation was 88.4% (86.6% for the TPS group and 94.7% for the NKI group, p=0.447). After crossover of the techniques, the final success rate was 95.3%. The complication rate was 20.9% in patients with TPS and 15.8% in patients with NKI (p=0.753).ConclusionsThe use of different strategies based on the presence of unintended pancreatic cannulation may help increase the success rate for difficult biliary cannulation without increasing complication rates.

Managing Difficult Cannulations in Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Control Trial Study of Precut Needle Knife Sphincterotomy versus Transpancreatic Sphincterotomy Technique

“…In this study, successful cannulations in difficult cannulation cases between TPS and NKS were the same as the result of the previous study from Lee et al 15 The procedural related complications between TPS and NKS were similar as the previous studies from Lee et al 15 , Catalano et al 16 , and Zang et al 24 Although TPS was not shown to be better than NKS in increasing the rate of successful cannulations, both cannulation techniques could increase the rate of successful cannulations in difficult cannulation cases. In this study, there were 286 participants who met the inclusion criteria and 52 (18.2%) of them were difficult cannulation cases.…”

“…NKS has been used to overcome difficult cannulations by many institutions for a long time with evidence of an increasing successful cannulation rate to 92-96.9% [7][8][9] , and TPS, a newer technique, described by Goff in 1995 10 , has also been used by ERCP operators with 72.5-97.3% cannulation success rate. [11][12][13][14][15] According to previous studies, the procedural related complications in NKS and TPS were 10-24.2% 7-9 and 11.1-5.8% 11,15 respectively. There were several studies that evaluated successful cannulation rates and complication rates between NKS and TPS techniques.…”

“…There were several studies that evaluated successful cannulation rates and complication rates between NKS and TPS techniques. The randomized controlled trial from Catalano et al 16 demonstrated higher a successful cannulation rate in TPS than with NKS while the complication rate was the same; a study from Lee et al 15 showed a similar successful cannulation rate and complication rate between TPS and NKS. Therefore, the use of NKS or TPS to achieve a successful cannulation rate is still being debated.…”

Transpapillary selective bile duct cannulation technique: Review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004

“…One hundred twenty‐four articles were judged not suitable for pooled analysis based on their abstracts. After vetting was complete, 69 articles were reviewed.…”

Prospective Evaluation of Transpancreatic Sphincterotomy Comparing to Needle-knife Precut in Difficult Biliary Cannulation: Short-and Long-term Outcomes

“…Different techniques are reported in the literature regarding cannulation of the papilla in the case of cannulation difficulty [4][5][6][7] . Transpancreatic sphincterotomy (TPS) is a technique used for exposing the bile duct orifice by making an incision through the septum between biliary duct and pancreatic.…”