Difficult biliary cannulation in patients with distal malignant biliary obstruction: An underestimated problem?

Fugazza, Alessandro; Troncone, Edoardo; Amato, Arnaldo; Tarantino, Ilaria; Iannone, Andrea; Donato, Giulio Di; D’Amico, Ferdinando; Mogavero, Giuseppe; Amata, Michele; Fabbri, Carlo; Radaelli, Franco; Occhipinti, Pietro; Repici, Alessandro; Anderloni, Andrea

doi:10.1016/j.dld.2021.07.010

Cited by 23 publications

(20 citation statements)

References 43 publications

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“…It has been demonstrated that the frequency of difficult biliary cannulation is increased in patients with malignant strictures. 27,28 In the presented study, 52 (50.5%) out of 103 patients having malignant stricture required precut cannulation correlatively. In addition, it was observed that CPS was more preferred than NKF in this patient group (P = 0.019).…”

Section: Discussionmentioning

confidence: 61%

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Başpinar¹,

Ödemiş²,

Erdoǧan³

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic tool for many biliary diseases. Selective biliary cannulation is the first step of the treatment process. Needle knife fistulotomy (NKF) and conventional precut sphincterotomy (CPS) are widely used in difficult biliary cannulation. However, there are different results in their effectiveness and safety. This study aimed to compare both methods regarding cannulation success and adverse event profile.Materials and Methods: All eligible consecutive patients with naive papillae who underwent biliary ERCP by a single experienced endoscopist over a 3-year period were included retrospectively. The standard cannulation method with a guidewire-loaded sphincterotome was initially used for biliary cannulation in all patients. Cannulation was accepted as difficult in the case of failure of standard cannulation within 5 minutes or despite 5 attempts or insertion of the guidewire to the pancreatic duct 5 times. Three modalities in patients with difficult biliary cannulation were employed according to the structure and configuration of the papillae in addition to unintentional pancreatic cannulation: (1) NKF, (2) CPS, (3) Double guidewire technique or guidewire orientation/ precut following pancreatic stenting. Latter was excluded to enable direct comparison between NKF and CPS groups.Results: A total of 644 patients were recruited. Analyses were performed with 541 patients after the exclusion of 103 patients. Mean (SD) age was 60.4 (18.2) years, and 257 (47.5%) patients were male. While standard cannulation was successful in 366 (67.6%), difficult biliary cannulation was observed in 175 (32.4%) patients. NKF was performed in 101 (57.7%) patients, and cannulation success was 100% in the first ERCP session. In contrast, CPS was performed in 74 (42.3%) patients with a lower cannulation success rate (79.7%) than NKF (P < 0.001). Post-ERCP pancreatitis rate was higher in CPS (9.5%) than NKF group (3.0%, P = 0.063). Bleeding and cholangitis were similar in both groups.Conclusions: In patients with difficult biliary cannulation with appropriate papillary structure and configuration, NKF should be used as the first choice in experienced hands because of high biliary cannulation success and low Post-ERCP pancreatitis risk.

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Section: Discussionmentioning

confidence: 61%

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Başpinar¹,

Ödemiş²,

Erdoǧan³

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Five studies listed in Table 5 stated biliary stricture as a predictive factor of DBC. According to Fugazza et al., 56.4% (N = 351) of patients with distal malignant biliary obstruction presented a DBC [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center

Abdallah¹,

Hamzaoui²,

Mahmoudi³

et al. 2022

Heliyon

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“…The bile duct is then accessed through the papilla and the drainage is obtained by placing a biliary stent to restore the bile flow toward the duodenum [ 23 ]. As mentioned above several advanced techniques have been developed, over the past years, to improve cannulation success rates, including precut (papillotomy vs. fistulotomy), the double-guidewire technique, and pancreatic duct access-assisted cannulation [ 5 , 30 ].…”

Section: Mechanisms Of Actionmentioning

confidence: 99%

“…Endoscopic retrograde cholangiopancreatography (ERCP) is considered as the first option in the management of malignant biliary obstruction, with rates of successful deep cannulation ranging from 89% to 92% using conventional techniques [ 1 , 2 , 3 ]. Common causes of ERCP failure may include periampullary diverticulum or ampullary distortion due to malignant infiltration [ 4 ], nevertheless advanced endoscopic techniques (i.e., double wire-guided technique, pre-cut, transpancreatic papillary septotomy) have shown to improve cannulation rates by up to 97% in such cases [ 5 , 6 ]. Sometimes the papilla remains non-accessible at all because of gastric outlet obstruction (GOO) or surgically altered gastrointestinal (GI) anatomy due to different (benign or malignant) conditions [ 4 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm

et al. 2022

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Endoscopic retrograde cholangiopancreatography (ERCP) is considered as the first option in the management of malignant biliary obstruction. In case of ERCP failure, percutaneous transhepatic biliary drainage (PTBD) has been conventionally considered as the preferred rescue strategy. However, the use of endoscopic ultrasound (EUS) for biliary drainage (EUS-BD) has proved similarly high rates of technical success, when compared to PTBD. As a matter of fact, biliary drainage is maybe the most evident paradigm of the increasing interconnection between ERCP and EUS, and obtaining an adequate informed consent (IC) is an emerging issue. The aim of this commentary is to discuss the reciprocal roles of ERCP and EUS for malignant biliary obstruction, in order to provide a guide to help in developing an appropriate informed consent reflecting the new biliopancreatic paradigm.

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Difficult biliary cannulation in patients with distal malignant biliary obstruction: An underestimated problem?

Cited by 23 publications

References 43 publications

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center

Informed Consent for Endoscopic Biliary Drainage: Time for a New Paradigm

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