Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation

이종균; 이광혁; 이규택; 박윤경; 이민지; 이윤정

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자료유형: 학술저널

저자정보: 이종균 이광혁 이규택 박윤경 이민지 이윤정

저널정보: 거트앤리버 발행위원회 Gut and Liver Gut and Liver 제9권 제4호

발행연도: 2015.1

수록면: 534 - 539 (6page)

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Background/Aims: Several precut techniques have been used to gain biliary access for difficult cases. The aim of this study was to evaluate the success and complication rates of two precut techniques, transpancreatic septotomy (TPS) and needle knife infundibulotomy (NKI), in difficult biliary cannulation due to the presence of unintended pancreatic cannulation. Methods: Eighty-six patients who failed standard biliary cannulation were included. TPS was performed when we failed to achieve biliary access despite 5 minutes of attempted cannulation or when more than three attempted unintended pancreatic cannulations occurred. If deep cannulation was not achieved within 5 minutes for any duct, NKI was performed. If this failed, we crossed over to the other technique in the second attempt. Results: The initial total success rate of biliary cannulation was 88.4% (86.6% for the TPS group and 94.7% for the NKI group, p=0.447). After crossover of the techniques, the final success rate was 95.3%. The complication rate was 20.9% in patients with TPS and 15.8% in patients with NKI (p=0.753). Conclusions: The use of different strategies based on the presence of unintended pancreatic cannulation may help increase the success rate for difficult biliary cannulation without increasing complication rates.

#Difficult biliary cannulation #Cholangiopancreatography #endoscopic retrograde #Needle knife infundibulotomy #Transpancreatic septotomy

참고문헌 (21)

참고문헌 신청

Catalano MF / 2004 / Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: comparison with standard pre-cut papillotomy / Gastrointest Endos

Chan CH / 2012 / Wire assisted transpancreatic septotomy, needle knife precut or both for difficult biliary access / J Gastroenterol Hepatol 27 : 1293 ~ 1297

Cotton PB / 1991 / Endoscopic sphincterotomy complications and their management: an attempt at consensus / Gastrointest Endosc 37 : 383 ~ 393

Freeman ML / 1996 / Complications of endoscopic biliary sphincterotomy / N Engl J Med 335 : 909 ~ 918

Freeman ML / 2001 / Risk factors for post-ERCP pancreatitis: a prospective, multicenter study / Gastrointest Endosc 54 : 425 ~ 434

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