Difficult biliary cannulation during ERCP: How to facilitate biliary access and minimize the risk of post-ERCP pancreatitis

Testoni, Pier Alberto; Testoni, Sabrina Gloria Giulia; Giussani, Antonella

doi:10.1016/j.dld.2011.01.019

Cited by 64 publications

(61 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a meta-analysis from Cennano et al [20], in the five studies in which a needle-knife precut was performed, the primary success of NKF ranged from 75% to 92%, and the overall NKF success (including repeated ERCPs) varied from 79% to 97%. Our overall biliary cannulation rate above the 95% barrier was comparable to other reports from tertiary centers with experience in precut [3,4,21].…”

Section: Discussionsupporting

confidence: 91%

“…Although precut is known to increase the primary biliary cannulation rate, the safety rate of this rescue technique is still under debate and it has been shown to be an independent risk factor for post-ERCP pancreatitis [3,4,8,9]. Moreover, certain reports suggest that a nondilated CBD diameter may be a risk factor for complications, especially in the setting of Sphincter of Oddi Dysfunction (SOD) [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

“…However, even in experienced hands, biliary cannulation may fail in up to 15-35% of cases when using standard methods alone, in the first ERCP [3,4]. In this subset of patients, additional cannulation techniques are needed to access the bile duct in order to continue with the ERCP [1,5].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Safety and efficacy of precut needle-knife fistulotomy

Lopes

Dinis-Ribeiro

Rolanda

2014

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

OBJECTIVE. Although precut is considered an useful alternative when standard methods of biliary access have failed, there is some controversy about it's safety. The study aim was to evaluate the effectiveness of needle-knife fistulotomy (NKF) after a difficult biliary cannulation and whether common bile duct (CBD) diameter influenced complications. MATERIAL AND METHODS. Between November 2006 and December 2010, a total of 1087 consecutive patients with naive papilla were submitted to endoscopic retrograde cholangiopancreatography (ERCP) for biliary access, in an affiliated university hospital. If the biliary cannulation was unsuccessful after 12-15 min, a NKF was performed. The main outcomes were biliary cannulation rate, NKF success and post-ERCP complications. RESULTS. Biliary cannulation by standard methods was successful in 883 patients (81%). In the remaining 204 patients, NKF was performed and allowed CBD access in 166 (81%), leading to a 96% cannulation rate. A second ERCP was performed in 25 patients, with an NKF success of 90% and an overall biliary cannulation rate of 98%. The post-ERCP complication rate was 7.9% (n = 16) with a 6.4% pancreatitis rate and no deaths. The complication for patients with a CBD ≤ to 4 mm was 13.9% compared with 4.5% in the remaining patients (OR = 3.39, p = 0.024). CONCLUSIONS. NKF is a safe and highly useful method of accessing the CBD in the setting of a difficult biliary cannulation. Despite its safety profile, extra caution is needed when applying NKF to patients with thin bile ducts.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and efficacy of precut needle-knife fistulotomy

Lopes

Dinis-Ribeiro

Rolanda

2014

Scandinavian Journal of Gastroenterology

View full text Add to dashboard Cite

show abstract

“…The overall biliary cannulation rate higher than 90% obtained in this study was also comparable to other reports from tertiary centers. 3,6,9 When a second ERCP was performed in the primary failures, the overall CBD cannulation improved to more than 96% in both groups. The strategy of performing a second ERCP when an NKF is unsuccessful in the first ERCP was highly effective and safe, as previously reported.…”

Section: Discussionmentioning

confidence: 99%

Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

Lopes

Dinis-Ribeiro

Rolanda

2014

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

show abstract

“…Siegel et al reported the first precut papillotomy with a traction papillotome in 1980 [5,6,24]. Subsequently, in 1986, Huibregtse et al reported a new precut technique, in which the incision of the papillary roof was performed by needle knife [1,7,25].…”

mentioning

confidence: 99%

Untitled

2016

Endosc Int Open

View full text Add to dashboard Cite

Difficult biliary cannulation during ERCP: How to facilitate biliary access and minimize the risk of post-ERCP pancreatitis

Cited by 64 publications

References 62 publications

Safety and efficacy of precut needle-knife fistulotomy

Safety and efficacy of precut needle-knife fistulotomy

Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

Untitled

Contact Info

Product

Resources

About