Background and study aims: Transpancreatic septotomy can be used instead of other precut techniques to facilitate
bile duct cannulation after multiple failed attempts. Within the framework of a prospective
randomized study on pentoxifylline, precut cases were retrospectively analyzed.
Patients and methods: Of 320 endoscopic retrograde cholangiopancreatographies (ERCPs) in 306 patients with
various indications who had a naïve papilla, 34 cases of transpancreatic septotomy
were identified and compared with 15 needle-knife sphincterotomies; six patients had
received both techniques for bile duct access. Complications were defined according
to consensus criteria.
Results: In the 55 patients in whom precutting techniques were employed, the use of both techniques
alone or in combination resulted in a final common bile duct cannulation rate of 81.8
%. Five patients developed complications (9.1 %). Of the two cases of pancreatitis
(3.6 %), one was mild and one severe (combined group). Of the three cases with hemorrhage,
one was mild (transpancreatic septotomy) and two severe (needle knife). In patients
who underwent conventional pull-type sphincterotomy (n = 242), 6.2 % developed complications
(nine pancreatitis and six hemorrhage).
Conclusion: In cases of difficult bile duct cannulation, transpancreatic septotomy seems to be
a safe alternative to needle-knife precutting with reasonable success rates. It should
be studied in prospective randomized trials.
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D. Kapetanos, MD
George Papanikolaou Hospital
Gastroenterology Department
Thessaloniki
Greece 57010
Fax: +30-2310-359217
Email: dkapetan@otenet.gr