Prophylactic Pancreas Stenting Followed by Needle‐knife Fistulotomy in Patients With Sphincter of Oddi Dysfunction and Difficult Cannulation: New Method to Prevent Post‐ercp Pancreatitis

Madácsy, László; Kurucsai, G.; Fejes, R; Székely, A; Székely, Iván

doi:10.1111/j.1443-1661.2008.00819.x

Cited by 37 publications

(17 citation statements)

References 31 publications

(61 reference statements)

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“…However, a stent might make biliary cannulation with a sphincterotome troublesome; a precut can be easier in these cases. Two studies suggested that a needle-knife biliary sphincterotomy over a pancreatic stent is safer than a conventional pull-type biliary sphincterotomy without a stent in patients with sphincter of Oddi dysfunction [27,28]. Multiple manipulations of the ampulla of Vater before pancreatic stenting or frequent contrast injections might be a risk factor.…”

Section: Discussionmentioning

confidence: 99%

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study

et al. 2014

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BackgroundNumerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP.MethodsThis prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time > 5 min, papillary contacts > 5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation ≥ 3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications.ResultsInitially, a total of 140 (19.7%) patients with DBC underwent EPF (n = 71) and DGC (n = 69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P < 0.001). The mean successful cannulation time (standard deviation) was 559.4 (412.8) seconds in EPF, 314.8 (65.2) seconds in DGC, and 706.0 (469.4) seconds in PPS (P < 0.05). The DGC group had a relatively low successful cannulation rate (47.8%) but had a shorter cannulation time compared to the other groups due to early switching to the PPS method in difficult or failed DGC. Post-ERCP pancreatitis developed in 14 (10%) patients (9 mild, 1 moderate), which did not differ significantly among the groups (P = 0.870) or compared with the conventional group (P = 0.125).ConclusionsBased on the sequential protocol analysis, EPF, DGC, and PPS may be safe and feasible for DBC. The use of EPF in selected DBC criteria, DGC in unintentional pancreatic duct cannulations, and PPS in failed or difficult DGC may facilitate successful biliary cannulation.

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Section: Discussionmentioning

confidence: 99%

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study

et al. 2014

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“…Unfortunately, none of these has stood the test of time. Since 2003, the placement of small caliber (≤ 5 French gauge) plastic pancreatic duct stents was shown in multiple studies to be a reliable way for preventing severe (necrotizing) pancreatitis, if placed early in the procedure (ie, before significant instrumentation) [14,15]. A fascinating newcomer in the PEP pharmacoprophylaxis area is vardenafil, a phosphodiesterase type 5′-inhibitor, which is marketed for erectile dysfunction in men.…”

Section: Sod With An Intact Gallbladder?mentioning

confidence: 99%

Sphincter of Oddi Dysfunction

Baillie

2010

Curr Gastroenterol Rep

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Sphincter of Oddi dysfunction (SOD) is a poorly-understood disorder, typically presenting as postcholecystectomy, "biliary-type," right-sided abdominal and/or chest wall pain. Most patients referred to specialist clinics for work-up of presumed SOD do not, in fact, have anything wrong with their bile ducts or biliary sphincter mechanisms. A careful history and focused physical examination will often identify the true source of the pain syndrome, ranging from chest wall costochondritis and nerve injury at surgical trochar sites, to gastroparesis and visceral hypersensitivity ("irritable bowel"). The Rome III classification of functional gallbladder and biliary disorders defines SOD as episodic (not daily) pain lasting more than 30 min, which is disruptive of normal activities and not associated with bowel upset. It is not relieved by gastric acid suppression or antispasmodics. Other causes of abdominal pain must be excluded. Standard work-up includes endoscopic retrograde cholangiopancreatography (ERCP) with biliary manometry, which risks post-ERCP pancreatitis, especially in young women with normal bile ducts and liver serology. Noninvasive tests for SOD, such as timed ("gated") cholecystokinin (CCK)-stimulated hepatobiliary iminodiacetic acid (HIDA) scans and secretin-stimulated magnetic resonance cholangiopancreatography, are imperfect and still evolving. Although many doubt the very existence of SOD, a multidisciplinary approach to the management of pre- and postcholecystectomy abdominal pain syndromes is long overdue.

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“…Assuming successful application of the technique, standard wire-guided cannulation can be undertaken and the opening extended by standard sphincterotomy technique. Again, we recommend prophylactic pancreatic duct stenting when undertaking access papillotomy/ fistulotomy [17].…”

Section: Normal Anatomymentioning

confidence: 99%

Difficult Biliary Cannulation

Lynch

Evans

2010

Curr Gastroenterol Rep

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Endoscopic retrograde cholangiopancreatography (ERCP) is the most technically challenging procedure routinely performed by endoscopists. ERCP cannulation requires the insertion of a subcentimeter catheter through a tiny orifice at a distance of almost a meter from the operator. Only after successful cannulation of the bile duct can the real "business" of ERCP be performed (eg, sphincterotomy, stone extraction, stent placement). Selective bile duct cannulation is all the more exacting due to the occasional anatomic challenge (eg, postsurgical anatomy, duodenal stricture) or wayward catheter. Serious morbid complications can and do occur, even in the hands of the most gifted and facile endoscopists. Although there are some "tricks" to facilitate successful cannulation of the bile duct, experience "trumps" all tricks. Of greatest importance when faced with a difficult cannulation is the recognition of one's personal limitations.

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Prophylactic Pancreas Stenting Followed by Needle‐knife Fistulotomy in Patients With Sphincter of Oddi Dysfunction and Difficult Cannulation: New Method to Prevent Post‐ercp Pancreatitis

Cited by 37 publications

References 31 publications

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study

Sphincter of Oddi Dysfunction

Difficult Biliary Cannulation

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