Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

Lopes, Luís; Dinis-Ribeiro, Mário; Rolanda, Carla

doi:10.1016/j.gie.2014.03.014

Cited by 46 publications

(41 citation statements)

References 22 publications

(30 reference statements)

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“…High-volume endoscopists tend to use NSAIDs less frequently than low-volume endoscopists. This observation is puzzling and may be related to the idea that guidelines do not apply to endoscopists who already have low rate of post-ERCP adverse events [27]. In fact, there was no randomized control trial in which the protective role of NSAIDs was evaluated in centers with low incidence of adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the most frequently used techniques, conventional precut (46.4%) and fistulotomy (46.4%) were the two most common precut techniques used by Portuguese endoscopists, with only 2 endoscopists reporting using another variant. Despite the recommendations and the recent evidence pointing to fistulotomy as the precut technique of choice, since it decreases the risk of PEP as well as the overall duration of ERCP especially if performed early in the cannulation algorithm, there were 13 endoscopists (46.4%) who opted for conventional precut [27, 32]. This observation can be explained in part by the fact that conventional precut was perceived as easier to learn and perform as well as less dangerous when compared to fistulotomy.…”

Section: Discussionmentioning

confidence: 99%

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ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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Background/Aims: Recently the European Society of Gastrointestinal Endoscopy delivered guidelines on the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and on the papillary cannulation and sphincterotomy techniques at endoscopic retrograde cholangiopancreatography (ERCP). There are no data concerning current practices in Portugal. The aim of this study was to capture practice patterns of Portuguese pancreaticobiliary endoscopists with special interest in the prevention of PEP and cannulation techniques. Methods: A written survey was distributed to all pancreaticobiliary endoscopists attending the first Portuguese meeting dedicated to ERCP in November 2016. The main outcome measures were: technique used for standard biliary cannulation, use of nonsteroidal anti-inflammatory drugs (NSAIDs) in PEP, attempting prophylactic pancreatic stenting after using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation was difficult, and use of precut as the first rescue technique when biliary cannulation was difficult. Results: Completed surveys were collected from 28 of the 32 pancreatobiliary endoscopists attending the meeting (answer rate 87.5%). Biliary cannulation was performed using a guidewire access technique by the majority (77%), usually with a sphincterotome. When cannulation was unsuccessful, precut was the first choice for 70%. NSAIDs were administered routinely for PEP by only 54%; PGW-assisted biliary cannulation was the first choice after failed standard cannulation for a minority of them, and only 27% reported to routinely attempt insertion of a pancreatic stent. High-volume endoscopists (> 150/year) tended to use NSAIDs and to insert a stent in PGW-assisted cannulation less often than low-volume-endoscopists (50 vs. 83.3%, p < 0.01, and 40 vs. 100%, p < 0.01, respectively). Precut was started without prior formal training by more than half of the endoscopists. Conclusions: There is a pronounced discrepancy between evidence-based guidelines and current clinical practice. This discrepancy is more pronounced in PEP prophylaxis, especially among high-volume endoscopists. Some advanced techniques in ERCP are initiated unsupervised, without any previous formal training. Key Message: There is a significant gap between guidelines and routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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“…Precut biliary sphincterotomy is considered an independent risk factor for PEP by many large studies. Some studies had different opinion and they attributed the papillary trauma truly by repetitive attempts before precut sphincterotomy . A RCT in 2015, they enrolled 375 patients with difficult cannulation.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Some studies had different opinion and they attributed the papillary trauma truly by repetitive attempts before precut sphincterotomy. 18,19 A RCT in 2015, they enrolled 375 patients with difficult cannulation. The patients were randomized as early precut group and standard technique group.…”

Section: Revision Of the Atlanta Classification And Definitionsmentioning

confidence: 99%

Postendoscopic retrograde cholangiopancreatography pancreatitis

Shih

Hsu

Kuo

2019

The Kaohsiung J of Med Scie

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Endoscopic retrograde cholangiopancreatography (ERCP) has been a mainstay examination to clarify the biliary and pancreatic system. Not just diagnostic purpose, it could achieve therapeutic goal. Under the trend of more and more procedures about ERCP being interventional, the rate of adverse events after the procedure is increasing. Among them, post‐ERCP pancreatitis (PEP) is the most common and sometimes tremendous complication. This mini‐review will overview the PEP from definition, pathogenesis, and risk factors to prevention.

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“…51,[86][87][88][89][90][91] Meta-analyses support early precut when compared to ongoing cannulation attempts. [92][93][94] Definition of "early" and the precut technique are other variables.…”

Section: Procedures Techniquesmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

Tarnasky

Kedia

2017

Int J Gastrointest Interv

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Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and can be associated with tragic outcomes. Bleeding, perforation, and post-ERCP pancreatitis are the most common complications. Some events are unavoidable; others are associated with well described risk factors so that they can be either anticipated and/or measures can be taken for prevention or at least risk reduction. This review will focus on the more common complications after ERCP, their risk factors, and potential strategies for risk reduction. Additionally, recommendations for management of ERCP complications will be presented.

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Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

Abstract: Background: The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed.

Cited by 46 publications

References 22 publications

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Postendoscopic retrograde cholangiopancreatography pancreatitis

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

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