Endoscopy 2020; 52(05): 415
DOI: 10.1055/a-1107-2902
Letter to the editor

Access to the common bile duct

Israël Cemachovic
Gastroenterology, Dijon University Hospital, Dijon, France
› Author Affiliations

I read with interest the paper by Kurita et al. [1] comparing the use of a rotatable and conventional sphincterotome for selective bile duct cannulation by trainees. The result of the study was that there was no significant difference between the two devices. However, the main point of the conclusion was that “orientation of the papilla was the most significant factor relating to cannulation difficulty for trainees overall”.

The methods explained that endoscopic retrograde cholangiopancreatography (ERCP) was performed in a standard manner, with the patient under conscious sedation; however, the position of the patient, supine or prone, was not given.

Having trained fellows in ERCP for the past 30 years, I can confirm the conclusion of the paper; it is true that the most difficult aspect of achieving selective bile duct cannulation is being able to position the papilla in the center of the screen (or in the center of its upper part) and also to align the axis of the operating channel with that of the papilla itself, as the authors explain in their paper. Concerning these two goals, after having worked in two countries where the practices are different (Belgium – patient prone, and France – patient supine), it is clear to me that the prone position is the one that offers the easiest correct positioning of the tip of the endoscope just in front of the papilla, with the axis of the operating channel and the papilla quite parallel.

For a future study on how to improve traineesʼ access to the common bile duct, should we not just simply start by comparing the bile duct cannulation success rate according to the patientsʼ randomly assigned position, either supine or prone?



Publication History

Article published online:
22 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 
  • Reference

  • 1 Kurita A, Kudo Y, Yoshimura K. et al. Comparison between a rotatable sphincterotome and a conventional sphincterotome for selective bile duct cannulation. Endoscopy 2019; 51: 852-857