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
To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard access.
From July 2010 to May 2017, 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 endoscopic retrograde cholangiopancreatography, and complications (pancreatitis, bleeding, perforation) were recorded.
We included 102 patients (66 females and 36 males, mean age 59.11 ± 18.7 years). Group I and Group II had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in Group I 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) vs 2.0% (1 patient with perforation and pancreatitis) in Groups I and II, respectively (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.
Core tip: Biliary cannulation is the first step of therapeutic endoscopic retrograde cholangiopancreatography and can determine several complications. There are small numbers of papers regarding comparison between conventional cannulation vs fistulotomy. Our study is a well-designed approach in its matter. In fact, we compare the cannulation success, biochemical profile and complications of the papillary fistulotomy technique versus catheter and guidewire standard access. Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase, as the routine endoscopic access to the biliary tree, including difficult cases. Complications were similar in both groups.