Papillary fistulotomy vs conventional cannulation for endoscopic biliary access: A prospective randomized trial

Abstract

AIMTo compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard access.METHODSFrom July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire (Group I) and papillary fistulotomy (Group II). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications (pancreatitis, bleeding, perforation) were recorded.RESULTSWe included 102 patients (66 females and 36 males, mean age 59.11 ± 18.7 years). Group I and Group II had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in Group I had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access (Failure Group). The complication rate was 13.7% (2 perforations and 5 mild pancreatitis) vs 2.0% (1 patient with perforation and pancreatitis) in Groups I and II, respectively (P = 0.0597).CONCLUSIONPapillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.

Needle-knife fistulotomy vs. standard biliary sphincterotomy for choledocholithiasis: common bile duct stone recurrence and complication rate

“…In more detail, patients treated with ERCP + PF, as expected, showed a higher rate of perforation and PEP, but interestingly a lower rate of bleeding. The higher rate of perforation and PEP are in line with the previous literature 17 18 19 20 . Notably, it is difficult to define the actual cause-effect association between PF and PEP, as this is most likely due to the very high rate of “delayed” precut fistulotomy in the current cohort and not to PF itself 7 13 ; this seems to be corroborated by the fact that in the “early” precut group the rate of PEP was lower, although not statistically significant, likely due to the low sample size.…”

Difficult Biliary Cannulation: Should We Always Try a Second Ercp After a Failed Needle-Knife Fistulotomy?

“…The success of ERCP after a short interval can be explained due to the improvement of the edema and inflammation (17) , that allows better visualization of the site, and a safe and effective biliary cannulation. Cannulation of the papilla ostium rates usually reaches 80-95% (1)(2)(3)(4)(5) . In our study a cannulation rate of 76.7% can be justified by the fact that all procedures were performed by an advanced endoscopy fellow, and when cannulation was not possible, usually a NKF was precociously indicated, considering that this could prevent PEP and the fact that the fellows needed to perform the technique to achieve proficiency.…”

“…Endoscopic retrograde cholangiopancreatography (ERCP) is the standard diagnostic and treatment procedure for various pancreatic and biliary diseases (1) . A successful bile duct cannulation is a prerequisite for the realization of the ERCP and even in experienced hands, biliary cannulation can fail in 5-20% of the cases (1)(2)(3)(4)(5) . When biliary cannulation is not possible, additional techniques are necessary to continue the procedure and access the common bile duct (6) .…”

“…Despite the improvements in the gastrointestinal scopes and emergence of new catheters and guide-wires over the last decade, a standard technique has not been defined for difficult biliary cannulation. Needle-knife precut sphincterotomy, needle knife fistulotomy (NKF), transpancreatic sphincterotomy, double-guidewire and rendezvous are the most frequently performed techniques in this situation (5,7) .…”

Eventos adversos associados aos diferentes tipos de corrente elétrica empregados na papilotomia endoscópica: revisão sistemática e metanálise de ensaios clínicos randomizados

“…Tais complicações relacionam-se principalmente ao trauma da cateterização da via biliar e à papilotomia endoscópica. Deste modo, muitos estudos auxiliaram a uma maior compreensão desses eventos adversos e de seus respectivos fatores de risco, fornecendo medidas para evitá-las [5][6][7][8][9][10][11] .…”