Clinical Research
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 14, 2008; 14(10): 1514-1520
Published online Mar 14, 2008. doi: 10.3748/wjg.14.1514
Transnasal endoscopic retrograde chalangiopancreatography using an ultrathin endoscope: A prospective comparison with a routine oral procedure
Akihiro Mori, Noritsugu Ohashi, Takako Maruyama, Hideharu Tatebe, Katsuhisa Sakai, Takashi Shibuya, Hiroshi Inoue, Shoudou Takegoshi, Masataka Okuno
Akihiro Mori, Noritsugu Ohashi, Takako Maruyama, Hideharu Tatebe, Katsuhisa Sakai, Takashi Shibuya, Hiroshi Inoue, Shoudou Takegoshi, Masataka Okuno, Department of Gastroenterology, Inuyama Chuo Hospital, Inuyama 484-8511, Japan
Author contributions: Mori A designed research; Mori A, Ohashi N, Maruyama T, Tatebe H, Sakai K, Shibuya T, Inoue H and Takegoshi S performed research; Mori A and Okuno M wrote the paper.
Correspondence to: Akihiro Mori, MD, Department of Gastroenterology, Inuyama Chuo Hospital, Aichi 484-8511, Japan. a-mori@inuyamachuohospital.or.jp
Telephone: +81-568-628111
Fax: +81-568-628761
Received: December 13, 2007
Revised: January 28, 2008
Published online: March 14, 2008
Abstract

AIM: To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large-caliber side-viewing duodenoscope.

METHODS: The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups. We compared the requirements of esophagogastroduodenoscopy (EGD) prior to ERCP, rates and times required for successful cannulation into the pancreatobiliary ducts, incidence of post-procedure hyperamylasemia, cardiovascular parameters during the procedure, the dose of a sedative drug, and successful rates of endoscopic naso-biliary drainage (ENBD).

RESULTS: Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group. There was no significant difference in the rates or times for cannulation, or incidence of hyperamylasemia between the groups. However, the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy. Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group. ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required.

CONCLUSION: n-ERCP is likely a well-tolerable method with less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube. However, a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.

Keywords: Endoscopic retrograde chalangiopancreatography; Nasal endoscopy; Cardiovascular stress; Blood pressure; Sedation; Endoscopic naso-biliary drainage