Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 3978-3982
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.3978
Endoscopic transpancreatic septotomy as a precutting technique for difficult bile duct cannulation
Lin Miao, Quan-Peng Li, Ming-Hui Zhu, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji
Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Ming-Hui Zhu, Department of Digestive Medicine, Jingjiang City People’s Hospital, 214500 Jingjiang, Jiangsu Province, China
Author contributions: Miao L and Li QP contributed equally to this work; all the authors contributed to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lin Miao, MD, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, 211 Jiangjiayuan, Nanjing 210011, Jiangsu Province, China. miaolinxh@163.com
Telephone: +86-25-58509931 Fax: +86-25-58509931
Received: July 16, 2014
Peer-review started: July 22, 2014
First decision: September 27, 2014
Revised: October 10, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: April 7, 2015
Abstract

AIM: To evaluate the technique of transpancreatic septotomy (TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography (ERCP).

METHODS: Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth II gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients (36 transpancreatic septotomies and 33 needle-knife sphincterotomies).

RESULTS: Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy (NKS) groups were 97.2% (35/36) and 96.9% (32/33), respectively, which were not significantly different (P > 0.05). Complications occurred in 11 cases, including acute pancreatitis (n = 6), bleeding (n = 2), and cholangitis (n = 3). The total frequency of complications in the TS group was lower than that in the NKS group (8.3% vs 24.2%, P < 0.05).

CONCLUSION: Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.

Keywords: Cholangiopancreatography, Endoscopic retrograde, Transpancreatic septotomy, Needle-knife precut, Complication

Core tip: In this study, we describe that pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in endoscopic retrograde cholangiopancreatography (ERCP). Transpancreatic septotomy (TS) and needle knife sphincterotomy (NKS) markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer and effective than NKS.