Endosc Int Open 2016; 04(10): E1107-E1110
DOI: 10.1055/s-0042-115407
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Use of double wire-guided technique and transpancreatic papillary septotomy in difficult ERCP: 4-year experience

Connie Huang
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
,
Jonathan Kung
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
,
Yong Liu
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
,
Audrey Tse
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
,
Anuj Datta
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
2   David Geffen School of Medicine at UCLA, Division of Digestive Diseases, Los Angeles, CA, USA
,
Inder Singh
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
,
Viktor E. Eysselein
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
2   David Geffen School of Medicine at UCLA, Division of Digestive Diseases, Los Angeles, CA, USA
,
Sofiya Reicher
1   Harbor-UCLA Medical Center, Department of Medicine, Division of Gastroenterology & Hepatology, Torrance, CA, USA
2   David Geffen School of Medicine at UCLA, Division of Digestive Diseases, Los Angeles, CA, USA
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Weitere Informationen

Publikationsverlauf

submitted25. Januar 2016

accepted after revision02. August 2016

Publikationsdatum:
21. September 2016 (online)

Background and aims: Post-ERCP complications increase with repeated attempts at cannulation. We evaluated several advanced biliary cannulation techniques applied when the standard approach fails.

Methods: In total, 1873 consecutive patients underwent ERCP at our institution during the period 2010 – 2014. Guidewire-assisted (GA) cannulation with no contrast injection until deep biliary cannulation was considered the standard technique. Advanced techniques used were double wire-guided (DWG) cannulation, transpancreatic papillary septotomy (TPS), and needle-knife sphincterotomy (NKS). When GA cannulation failed, DWG cannulation was usually attempted first if the pancreatic duct (PD) wire was in place; if that failed, TPS or NKS was performed. Alternatively, TPS or NKS were performed alone. A prophylactic pancreatic stent was placed with repeated PD cannulation or PD contrast injection. During the last 2 years of review, indomethacin suppositories were given post-procedure to all patients who underwent advanced techniques.

Results: The overall biliary cannulation success rate was 97 % (1823/1873). Advanced techniques were used in 12 % of ERCPs (230/1873), with 87 % (200/230) success rate. DWG was used alone or in combination with other techniques in 58 % (134/230) of advanced cases, with 68 % (91/134) success rate. Biliary cannulation was achieved in 96 % (91/95) of procedures when DWG was used alone, 76 % (26/34) with TPS alone, 80 % (37/46) for NKS alone, and 84 % (46/55) with multiple techniques. The overall rate of post-ERCP pancreatitis was 0.4 %, with all patients treated conservatively.

Conclusion: In our experience at an urban tertiary care center, use of advanced techniques in difficult ERCP improved the overall success rate of biliary cannulation after standard technique failure without a significant increase in complication rate.

 
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