Aim: The aim of this study is to determine the success rate of biliary cannulation in cases where endoscopic retrograde cholangiopancreatography (ERCP) is repeated after failed precut sphincterotomy. Materials and Methods: In this retrospective study, consecutive ERCPs performed between August 2013 and June 2017 were included. Data was analyzed for indication of ERCP, success rate at initial cannulation attempt, use of precut sphincterotomy, biliary access rate after precut, repeat ERCP rate, and associated complications. Results: A total of 1872 ERCPs were included in the study. Of these, 55% were done for common bile duct stones, 37% for malignant biliary obstruction, and 8% for biliary leak. During the initial ERCP, 84.9% cases had successful biliary cannulation. Nearly 86.8% cases undergoing precut sphincterotomy achieved biliary access. Repeat ERCP was done in 28 cases after a median interval of 3 days and biliary cannulation was achieved in 78.5% cases. Conclusion: Repeat ERCP after 3 days in cases of failed initial precut sphincterotomy should be practiced and recommended as this allows definitive biliary therapy in majority of such patients and prevents morbidity and mortality from other invasive alternative therapies.
The endoscopic clips were first described by Hayashi in Japan in 1975. Since then, many different types of clips have been introduced to the gastroenterology practice. Over-the-scope clip (OTSC) or the “beer claw” was introduced in the year 2010. It works on the principle of dynamic compression and is applied over the scope like a band ligator. OTSC is a new endoscopic modality which can be used in acute gastrointestinal hemorrhage, iatrogenic perforation, anastomotic leak, and chronic fistula treatment with fairly good success rate and therefore, is now being considered as an alternative to surgery, especially in situations where surgery is not feasible.
Pseudoaneurysm is a known complication of pancreatitis associated with significant morbidity and mortality. Computed tomography (CT) localizes the pseudoaneurysm apart from the severity of underlying pancreatitis. Digital subtraction angiography with coil embolization is recommended treatment for pseudoaneurysm to avoid bleeding and surgery. However, in cases where angiographic coil embolization fails due to technical reasons, CT/ultrasonography‑ guided thrombin injection remains a viable option as described in literature. In the present case, role of endoscopic ultrasound‑guided thrombin injection into large pseudoaneurysm that was not feasible by angiographic occlusion has been highlighted. The procedure avoided surgery and its related complication.
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