Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial

Mariani, Alberto; Leo, Milena Di; Giardullo, Nicola; Giussani, Antonella; Marini, Mario; Buffoli, Federico; Cipolletta, Livio; Radaelli, Franco; Ravelli, P.; Lombardi, G; D'Onofrio, V.; Macchiarelli, Raffaele; Iiritano, E.; Grazie, Marco Le; Pantaleo, Giuseppe; Testoni, Pier Alberto

doi:10.1055/s-0042-102250

Cited by 63 publications

(66 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate of PEP was significantly lower in the early PS group (5.4% vs 12.1%; OR 0.35, 95% CI 0.16 –0.78). Subgroup analysis also found that the incidence of PEP was significantly lower with early PS compared to delayed PS (5.4% vs 14.1 %; OR 0.42, 95 % CI 0.17 –1.07) . However, the impact of PEP prophylactic measures after PS has never been specifically addressed, and in fact, there was no PEP prophylaxis in this study.…”

Section: Discussionmentioning

confidence: 56%

Comparative study of strategies for preventing post‐ERCP pancreatitis after early precut sphincterotomy for biliary access

Kwek

Song

et al. 2016

J of Digest Diseases

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 56%

Comparative study of strategies for preventing post‐ERCP pancreatitis after early precut sphincterotomy for biliary access

Kwek

Song

et al. 2016

J of Digest Diseases

View full text Add to dashboard Cite

show abstract

“…The patients were randomized as early precut group and standard technique group. Lower PEP rate was observed in early precut group (5.4% vs 12.1%) . If the patient with common bile duct dilation down to the papilla, some studies suggested fistulotomy is the preferred precut technique …”

Section: Risk Factorsmentioning

confidence: 92%

Postendoscopic retrograde cholangiopancreatography pancreatitis

Shih

Hsu

Kuo

2019

The Kaohsiung J of Med Scie

View full text Add to dashboard Cite

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.

show abstract

“…In a prospective, multicenter, randomized clinical trial, ERCP patients with early precut for difficult biliary access were found to have a lower rate of post-ERCP pancreatitis than the late precut group 5.4% (10/185) vs 14.1% (19/135). 9 …”

Section: Precut Needle Knife Papillotomy/ Suprapapillary Needle-knifementioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography cannulation in the difficult duct: Which technique should you pull out of your bag?

Ahmed

Wilcox

2017

Digestive Endoscopy

View full text Add to dashboard Cite

Golf and endoscopic retrograde cholangiopancreaticography (ERCP) share a commonality where the highs of the successes are balanced by the lows of the frustrations. ERCP cannulation is one of the most difficult maneuvers in gastrointestinal endoscopy and is a requirement for the procedure's therapeutic benefit. As such, many different techniques have been developed to facilitate cannulation. The mission of the procedure is to provide access to the biliary or pancreatic duct typically with a guidewire, which can then be used as a platform for therapeutic and diagnostic procedures. An inherent challenge in ERCP is that the operator must make use of a two-dimensional imaging surrogate through fluoroscopy and navigate the threedimensional biliary or pancreatic duct pathway. The advanced nature of this procedure lends itself to higher complication rates including post-procedure pancreatitis, bleeding, perforation and infection. Complications of ERCP have been evaluated by meta-analyses with pancreatitis reported at 3.5% of cases, bleeding at 0.3-2%, perforation <0.6% and infection <3%.1 Complications are also a function of factors associated with the patient, procedure and operator, resulting in variable susceptibility to the adverse outcomes of ERCP. 1,2Malcolm Gladwell in his book Outliers: The Story of Success suggests that 10 000 h of correctly carrying out a skill is required in order to obtain expertise.3 ERCP as a discipline is one such example, as its mastery requires the experience of over thousands of procedures. Many different techniques, equipment platforms, devices and strategies have been developed to assist ERCP cannulation.Standard cannulation techniques will involve use of a 5-7 Fr cannula or sphincterotome with either a blunt or tapered tip often with a guidewire. That wire will either be long (450 cm) or short (260 cm) with a straight or angled tip and usually 0.035 inches or 0.025 inches in diameter. The catheter would be positioned in front of Vater's ampulla and bowed to align along the biliary duct axis. Sometimes, the devices can be steered for better alignment with the papilla.The papillotome is inserted into the papillary orifice and the guidewire is advanced under fluoroscopic guidance until observed to enter the bile duct. Contrast injection is not always routinely administered prior to advancement of the guidewire into the common bile duct (CBD). Physicians will develop preferences based on their skill sets and that of their teams in order to provide the best outcome for their patients.The European Society of Gastrointestinal Endoscopy (ESGE) defines challenging biliary cannulation as five contacts with the papilla, or more than 5 min after the major ampulla has been located or after unintentional pancreatic duct cannulation or contrast injection. 4 At times, anatomy such as the shape, size or consistency of the ampulla, the position of the ampulla with a nearby diverticulum, gastrointestinal stricture or altered anatomy from prior surgery may contribute to the complexity.In this issue of ...

show abstract

Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial

Abstract: In patients with difficult biliary cannulation, early precut is an effective technique and can significantly reduce the incidence of PEP. Repeated biliary cannulation attempts are a real risk factor for this complication.

Cited by 63 publications

References 24 publications

Comparative study of strategies for preventing post‐ERCP pancreatitis after early precut sphincterotomy for biliary access

Comparative study of strategies for preventing post‐ERCP pancreatitis after early precut sphincterotomy for biliary access

Postendoscopic retrograde cholangiopancreatography pancreatitis

Endoscopic retrograde cholangiopancreatography cannulation in the difficult duct: Which technique should you pull out of your bag?

Contact Info

Product

Resources

About