Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy

Lee, Tae Hoon; Park, Sang Heum

doi:10.5946/ce.2016.103

Cited by 9 publications

(8 citation statements)

References 60 publications

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“…Despite the use of various tubes and guide wires for cannulation, the failure rate of bile duct cannulation remains high. [ 1 ] Endoscopic needle-knife precut papillotomy significantly improves the success rate of ERCP-based bile duct cannulation, but the rate of complications reaches 6% to 20%. [ 2 ] There is a thin septum between the pancreatic duct and common bile duct (Fig.…”

Section: Introductionmentioning

confidence: 99%

Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access

et al. 2018

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This study aimed to assess the clinical value of transprepancreatic septotomy indwelling guide wire or pancreatic duct stent in intractable endoscopic retrograde cholangiopancreatography (ERCP) for bile duct cannulation.Of the 2107 patients treated by ERCP, a total of 81 cases with difficult bile duct cannulation underwent transprebiliopancreatic septotomy (referred to as the septotomy group, 37 cases) and transprepancreatic septotomy with pancreatic duct stent (modified septotomy group, 44 cases). Success rates of cannulation and postoperative complications for both methods were compared.Among them, 77 cases were successfully administered bile duct cannulation. The success rates of the septotomy and modified septotomy groups were 91.89% and 97.73%, respectively, with no significant difference (P = .489). Of the 77 patients, 12 cases had complications. The septotomy group included 7 acute pancreatitis, 1 bleeding, and 1 biliary tract infection cases; while in the modified septotomy group, there were 1 acute pancreatitis, 1 bleeding, and 1 biliary tract infection cases. The occurrence rate of acute pancreatitis in the modified septotomy group was lower than that of the septotomy group (2.33% vs 20.59%) with a significant difference (P = .026).These findings indicate that transprepancreatic septotomy with pancreatic duct stent seems to be a safe and feasible operation with reducing complication rates.

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Section: Introductionmentioning

confidence: 99%

Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access

et al. 2018

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“…In cases of difficult biliary cannulation, rescue techniques, such as pancreatic guidewire-assisted cannulation or precut sphincterotomy are suitable in achieving biliary cannulation. 29 Reports have shown that rescue techniques are useful for patients with periampullary diverticulum. 12 In the current study, approximately three-fourths of the patients who underwent rescue techniques, including pancreatic guidewire-assisted cannulation and precut sphincterotomy within 5-10 min after initial cannulation, achieved successful selective cannulation within 5 min following the rescue technique.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones

Saito

Kadono²,

Shono

et al. 2022

Clin Endosc

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Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP.Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses.Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS.Conclusions: Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

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“…1 Currently GW is also widely used to facilitate primary selective biliary or pancreatic cannulation and pass tight ductal strictures. 2,3 Especially, as a procedure related factor, the use of GW during biliary cannulation might have a technical advantage and ability to reduce the frequency or severity of post-ERCP pancreatitis. Wireassisted cannulation technique can increase the primary cannulation success rate and reduce the risk or severity of post-ERCP pancreatitis compared with the standard contrast-injection method.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical selection of GWs usually depends on the preference of the operator, availability, and/or the type of procedure. 3,10 Studies that compare each basic property of GWs and clinical comparative studies are limited because of heterogenicities, especially for 0.025-inch GWs.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of a newly developed 0.025-inch guidewire for selective biliary access: Technical property analysis and a multicenter non-inferiority clinical trial

Park

Han

Lee

et al. 2022

Preprint

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A clinical efficacy study of 0.025-inch guidewires (GWs) according to mechanical property analysis has not been reported yet. This study was designed to evaluate the clinical efficacy of a newly developed 0.025-inch GW for biliary access according to the basic mechanical property. Commercially available 0.025-inch GWs were in vitro tested based on parameters of mechanical property. Patients with naïve papilla requiring diagnostic or therapeutic ERCP were randomly assigned to an experimental 0.025-inch newly developed GW or a control 0.025-inch GW group. Technical success rate of wire-guided cannulation (WGC), difficult biliary cannulation (DBC), and adverse event rates were measured in this multicenter randomized trial. The technical success rate of primary WGC was 79.1% (151 of 191) in the experimental group and 70.8% (131 of 185) in the control group (95% two-sided confidence interval: 8.25%; p<0.001; for a noninferiority margin of 15%). The technical success rate including cross-over to each other was also non-inferior. However, the chi-square test showed a statistical difference (81.7% vs. 68.1%; p=0.002). Median biliary cannulation time was shorter in the experimental group (53 seconds vs. 77 seconds; p=0.047). The rate of DBC was more frequent in the control group (34.6 % vs. 50.3% p=0.002). Multivariate analysis revealed that control group was one of contributing factors for DBC. Overall rate of post-ERCP pancreatitis was not different (4.7% vs. 8.6%; p=0.125). WGC using a newly developed GW with superior physical performance GW in a bench test showed similar clinical efficacy and the rate of DBC was significantly lower in experimental GW.

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Optimal Use of Wire-Assisted Techniques and Precut Sphincterotomy

Cited by 9 publications

References 60 publications

Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access

Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access

Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones

Efficacy of a newly developed 0.025-inch guidewire for selective biliary access: Technical property analysis and a multicenter non-inferiority clinical trial

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