Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

Fukatsu, Hirotoshi; Kawamoto, Hirofumi; Kato, Hironari; Hirao, Ken; Kurihara, Naoko; Nakanishi, Takashi; Mizuno, Osamu; Okamoto, Yuko; Ogawa, Tsuneyoshi; Ishida, Etsuji; Okada, Hiroyuki; Sakaguchi, Kohsaku

doi:10.1007/s00464-007-9473-8

Cited by 31 publications

(45 citation statements)

References 24 publications

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“…The reported time limits within which the regularly used SBDC technique is used vary between 10 and 30 min [3][4][5][6][11][12][13]. The 15-to 30-min limits are used less consistently [14][15][16][17][18][19][20]. More refined methodology appears to be necessary to clarify the definition of the allocated procedure time regarding SBDC.…”

Section: Discussionmentioning

confidence: 99%

A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study

Kawakami

Maguchi

Mukai

et al. 2012

Gastrointestinal Endoscopy

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Background: Wire-guided cannulation (WGC) with a sphincterotome for selective bile duct cannulation (SBDC) has been reported to have a higher success rate and lower incidence of post-ERCP pancreatitis (PEP) than conventional methods in some randomized controlled trials (RCTs) that were both single-center and limited to only a few endoscopists.Objective: To estimate the difference in SBDC according to the method and catheter used in a multicenter and multi-endoscopist study. Design:A prospective multicenter RCT with a 2-by-2 factorial design. Setting: Fifteen referral endoscopy units.Patients: In total, 400 consecutive patients with naïve papilla who were candidates for ERCP were enrolled and randomized.Interventions: Patients were assigned to 4 groups according to combined catheter (sphincterotome (S) or catheter (C)) and method (with/without guidewire (GW)). Main Outcome Measurements:Success rate of SBDC in 10 min, time for SBDC, fluoroscopic time and incidence of complications. Results:There was no significant difference in SBDC success rate between with-and without-GW, between C and S, or between the 4 groups (C+GW, C, S+GW, and S). WGC had a tendency to significantly shorten cannulation and fluoroscopic times only in approximately 70% of patients in this study in whom SBDC was achieved in 10 min or less (P = 0.036 and 0.00004, respectively). All 4 groups resulted in similar outcomes in PEP (4%, 5.9%, 2%, and 2.1%, respectively).Limitations: Non-double-blinded study. Kawakami-4 4Conclusions: WGC appears to significantly shorten cannulation and fluoroscopic times.However, neither the method nor type of catheter used resulted in significant differences in either SBDC success rate or incidence of PEP in this RCT. Kawakami-5 5 Keywords:Wire-guided cannulation; Selective bile duct cannulation; Post-ERCP pancreatitis; Randomized controlled trial; Cannulation time; Fluoroscopic time; Radiation exposure time Kawakami-6 6 INTRODUCTIONBiliary cannulation is the most basic procedure for performing biliary interventions; however, no standard has been established to date. The success rates are considered to be related to 3 factors: the kind of catheter, cannulation method, and the skill of the endoscopist. The complication rates are also related to 3 factors: patient, procedure factors, and operator expertise. Cannulations using a sphincterotome with wire-guided cannulation (WGC) instead of the conventional catheter, with contrast medium injection, are gradually performed in many countries. These new methods were reported to be superior to conventional techniques in terms of both success rate and the incidence of post-ERCP pancreatitis (PEP) in some randomized studies [1][2][3][4][5]. However, those studies were performed by either a single or, at most, two skilled endoscopists in a single center [1,2,4,5]. Thus, these data cannot be generalized more widely.In these previous studies, 5° backward-oblique angle therapeutic duodenoscopes (BOAD) were used. In Japan, standard duodenoscopes have traditionally been 15° BOAD. Thu...

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Section: Discussionmentioning

confidence: 99%

A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study

Kawakami

Maguchi

Mukai

et al. 2012

Gastrointestinal Endoscopy

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confidence: 92%

Female gender may give rise to difficulties in endoscopic and laparoscopic biliary surgery

et al. 2008

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We read with interest the fine article by Fukatsu and co-authors on unsuccessful cases of biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) in which the standard procedure was changed to a needleknife precut papillotomy [1].ERCP is frequently challenging even for an experienced endoscopist. The most usual problem at ERCP is difficulty in achieving selective cannulation of the common bile duct. In the recent large-scale prospective survey of ERCP practice in the UK overall deep cannulation was achieved in only 2,684 of 3,210 (84%) patients undergoing their first ever ERCP [2]. In the survey by Fukatsu et al.[1] the total success rate of biliary cannulation was as high as 99% (497 out of 501 patients) in a study population in which needleknife precut papillotomy was performed in 16% (n = 80) of cases. Recently, we described our indications, techniques and results of 1,703 consecutive first-time ERCPs [3], in which the overall success rate of bile duct cannulation was 97%. The needle-knife approach was employed in 10% of cases. These figures emphasize that, although every cannulation may be challenging and the results are not satisfactory at the country level, high success rates of bile duct cannulation can be reached in high-volume centres in which needle-knife papillotomy is routine practice in difficult cases.The main purpose of the study of Fukatsu et al. [1] was to scrutinize those patients who had to undergo needleknife precut papillotomy because standard manoeuvres did not lead to successful biliary cannulation. Multivariate analysis indicated that female gender, presence of left lobe hypertrophy after hepatectomy, history of Billroth I reconstruction, and malignant biliary stricture were risk factors associated with difficult biliary cannulation. In our opinion it is not surprising that anatomic factors such as left lobe hypertrophy, Billroth I reconstruction and malignant biliary stricture are associated with difficulties in achieving access into the bile duct. Instead, we find that the association between female gender and cannulation failure reported by Fukatsu et al. is a novel, interesting and important finding. To our knowledge, there are no earlier reports on this association in the literature, which perhaps was the reason why the authors did not discuss this finding in their discussion section. This novel finding of Fukatsu et al. is in accordance with earlier reports that female gender is a risk factor for post-ERCP pancreatitis [4]. We find that difficulties in cannulation in female patients may even play a pivotal role in the development of post-ERCP pancreatitis. Moreover, earlier reports have indicated that female gender is associated with severe iatrogenic bile duct injury during laparoscopic cholecystectomy as well [5].Traditionally, during the era of open surgery the male anatomy was known to make many abdominal operations such as bile surgery technically more demanding [6]. Nowadays, in the era of endoscopic and laparoscopic surgery, female gender seems to be a r...

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“…Thereafter a needle-knife papillotomy was performed. The needle-knife sphincterotomy was successful in 88% of cases during the first session [9] . In a study by Laasch et al involving 312 patients, a needle-knife precut was performed in 23 (7.4%) patients when cannulation by other means had failed.…”

Section: Needle-knife Precutmentioning

confidence: 99%

“…Of course, if endoscopic methods fail, the transhepatic route can be used directly without an endoscopist or the rendezvous technique can be applied, depending on the problem. [3,30] Standard catheter with guide wire 81 [3] Sphincterotome 78 to 84 [4,29] Sphincterotome with guide wire 97 to 99 [26,30] Success in difficult cannulation after primary failure with standard method Persistence 73 to 75 [2,49] Needle knife 67 to 91 [2,6,9,34,37] Erlangen knife 78 to 100 [32,50] Pancreatic sphincterotomy 91 to 100 [10,12,13,22,40,41] Pancreatic stent 97 to 100 [28,47] Pancreatic guide wire 73 to 93 [5,8] Pancreatitis rate after difficult cannulation Persistence 2-4 [2,49] Needle knife 1-11 [2,6,9,34,37] Erlangen knife 3-7 [32,50] Pancreatic sphincterotomy 0-12 [10,12,13,22,40,41] Pancreatic stent 5-7 [28,47] Pancreatic guide wire 0-2 [5,8] Randomized controlled tri...…”

Section: Solutions For Overcoming Difficult Cannulationmentioning

confidence: 99%

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Management of difficult bile duct cannulation in ERCP

Udd

Kylänpää²,

Halttunen³

2010

WJGE

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In Encoscopic Retrograde Cholangiopancreatography (ERCP), the main concern is to gain access into the bile duct while avoiding the pancreatic duct because of the risk of post-ERCP pancreatitis. Difficult cannulation is defined as a situation where the endoscopist, using his/her regularly used cannulation technique, fails within a certain time limit or after a certain number of unsuccessful attempts. Different methods have been developed to manage difficult cannulation. The most common solution is to perform a precut papillotomy either with a needle knife or with a sphincterotome with or without a guide wire. This review describes different methods to overcome cases of difficult cannulation. We will discuss the success rate and complication rates associated with different methods of reaching the biliary tract.

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Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

Abstract: Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

Cited by 31 publications

References 24 publications

A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study

A multicenter, prospective, randomized study of selective bile duct cannulation performed by multiple endoscopists: the BIDMEN study

Female gender may give rise to difficulties in endoscopic and laparoscopic biliary surgery

Management of difficult bile duct cannulation in ERCP

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