Endoscopic Sphincterotomy for Choledocholithiasis: A Prospective Single-Center Study on the Short-Term and Long-Term Treatment Results in 483 Patients

Wojtuń, Stanisław; Gil, Jerzy; Gietka, W.; M, Gil

doi:10.1055/s-2007-1004186

Cited by 69 publications

(48 citation statements)

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“…Precutting (transpancreatic pre-cut, needle-knife pre-cut, needle-knife fistulotomy, and needle-knife pre-cut over pancreatic stent) is the most popular technique when standard cannulation fails. In the search for an alternative technique when standard cannulation fails, fistulotomy above the papillary orifice has been considered in some studies [1][2][3][8][9][10] . In our study, we demonstrated that the starting point of the fistulotomy on the papilla (distal third, midportion or proximal third) and the length of the incision varied depending on the disorder being treated (bile duct stones, strictures, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…Transpapillary biliary cannulation is the preferred technique to enter the common bile duct (CBD), but access from the sphincter of Oddi to the biliary tract during ERCP is not always possible using standard cannulation techniques. The success rate for deep cannulation of the biliary tree during ERCP ranges between 80% and 95% in the hands of experienced endoscopists [1,2] . When standard cannulation is not possible, alternative techniques may be used: transpancreatic pre-cut, needle-…”

Section: Introductionmentioning

confidence: 99%

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Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Ayoubi¹,

Sansoè²,

Leone³

et al. 2012

WJGE

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AIM:To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS:Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi's syndrome. RESULTS:Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION:Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Ayoubi¹,

Sansoè²,

Leone³

et al. 2012

WJGE

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“…Similar limitations concern only laparoscopic evacuation of stones from the biliary tract (8). It is also believed that the performance of ERCP only with the wait and see approach, and the postponing of decision on cholecystectomy increase the choledocholithiasis recurrence rate, and many patients may develop complications requiring surgical intervention (6,7,9). The diagnosis of choledocholithiasis should be made by the least invasive methods (10-13), among of which the main ones are magnetic resonance cholangiopancreatography (MRCP) with sensitivity of 95% and specificity of 97%, and endoscopic ultrasound (EUS) with sensitivity of 93% and specificity of 93-97%, although, the latter is performed in rare cases due to the limited availability (11).…”

Section: Discussionmentioning

confidence: 99%

“…The value of the widely available percutaneous ultrasound examination is smaller in this respect and depends to a large extent on the experience of the technician. Obviously, the sensitivity and specificity of ERCP are high and reach 89-100%, but the diagnostic advantage of this examination is associated with its invasiveness, and this is why it should be performed only in patients with a potential requirement for intervention (4,6,8,12).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

Peterlejtner¹,

Szewczyk²,

Firkowski³

et al. 2012

Polish Journal of Surgery

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Results. The 883 (52%)patients with coexisted gall-bladder and biliary tract stones were the principal group. The second group included 580 (34.2%) patients with residual choledocholithiasis after cholecystectomy and biliary tract surgery. Moreover ERCP, ES and endoscopic evacuation of biliary stones have been urgently carried out in 159 (9.4%) cases with acute biliary pancreatitis. Lastly ERCP with re-sphincterotomy and removal of the stones was performed in 75 (4.4%) patients with recurrent choledocholithiasis. The procedure was effective in 1561 (92%) patients. When removal of the stones was not possible, decompression of the biliary tract by implantation of the plastic stent was done in 63 (3.7%) cases. Ineffective procedure was noted in 74 (4.3%) patients. The most commonly observed complication was acute pancreatitis. Because of: post ES bleeding, acute haemmorhagic and necrotic pancreatitis, impacted Dormia basket and peripapillary duodenal perforation 10 patients (0.5%) had to be operated. Two patients (0.1%) died. conclusions. 1. Endoscopic treatment of choledocholithiasis is highly effective but risk factors of complications with urgency an intensive conservative management and surgical intervention have to be considered. 2. After ES, if surgical evacuation of the stones have to be carry out, post operative biliary tract drainage (by T tube) is not necessary.

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“…Cannulation procedure is reported to achieve a success rate of 80-95% when performed by experienced endoscopists [5][6][7][8]. In cases where selective cannulation is not feasible, generally precut papillotomy techniques are performed.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Repeat ERCP: Analysis of a Four-Year Experience

Toros¹

2013

J Gastrointest Digest Sys

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In this trial, a total of 1010 ERCP procedures performed in 410 patients at the endoscopy department of our hospital between 2006 and 2010, were retrospectively evaluated. The age, gender, complaints, pre-procedure diagnosis, the radiologic and clinical results, number of procedure repetitions and the final diagnosis were assessed. The local Ethics Committee approved this retrospective study protocol. All of the procedures were performed by the same team of endoscopists with compatible levels of ERCP experience (Mean 5 years). At our department, pethidine HCl (0.3-0.5 mg/kg), midazolam (0.03-0.07 mg/kg) and hyoscine-N-butylbromide (0.3-0.6 mg/kg) are used in the ERCP procedures for premedication and additionally, cefazolin 1 gram intravenous is routinely administered for prophyllaxis one hour before the examination. During the procedure, oxygen saturation and heart rate are monitored by pulse-oximeter. The patients were those admitted to our hospital or referred from other healthcare centers. Statistical assessment was performed by evaluating the first ERCP procedures and the repeat procedure records. Chi-square test was used to statistically analyze the results. The level of significance was set at p<0.05.

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Endoscopic Sphincterotomy for Choledocholithiasis: A Prospective Single-Center Study on the Short-Term and Long-Term Treatment Results in 483 Patients

Cited by 69 publications

References 0 publications

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Endoscopic Treatment of the Choledocholithiasis - Effectiveness, Safety and Limitations of the Method

Evaluation of Repeat ERCP: Analysis of a Four-Year Experience

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