Published online Apr 28, 2018. doi: 10.3748/wjg.v24.i16.1803
Peer-review started: February 26, 2018
First decision: March 9, 2018
Revised: March 12, 2018
Accepted: March 25, 2018
Article in press: March 25, 2018
Published online: April 28, 2018
Successfully cannulating the biliary tract is important in the diagnosis and treatment of biliopancreatic diseases with endoscopic retrograde cholangiopancreatography (ERCP), but it can be associated with severe complications and mortality.
The number of papers regarding comparison between conventional cannulation versus fistulotomy is small. Our study is a well-designed approach in its matter.
To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique versus catheter and guidewire standard access.
Patients were prospectively randomized into two groups: cannulation with a catheter and guidewire (Group I) and papillary fistulotomy (Group II). Amylase, lipase and C-reactive protein at T0 as well as 12 h and 24 h after ERCP, and complications (pancreatitis, bleeding, perforation) were recorded. Comparison was made of the cannulation success, biochemical profile and complications of the papillary fistulotomy technique vs catheter and guidewire standard access.
We included 102 patients, and Groups I and II had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in GroupI had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access (Failure Group). The complication rate was 13.7% (2 perforations and 5 mild pancreatitis) in Group I versus 2.0% (1 patient with perforation and pancreatitis) in Group II (P = 0.0597).
Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.
The fistulotomy demonstrated safety similar to conventional cannulation and less local trauma into the ampulla, according to the levels of the amylase, lipase and C-reactive protein.