New Technique of Endoscopic Sphincterotomy with Iso-Tome® to Incise the Distal Papillary Roof in Patients with Choledocholiths and Choledochoduodenal Fistula
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Background/Aims: It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome® (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome® for cutting the distal PR. Methods: Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome® until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. Results: Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. Conclusions: The new technique of ES with the Iso-tome® is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths. (
Abstract
Background/Aims: It is sometimes difficult to incise the distal papillary roof (PR) completely in patients with choledocholiths and choledochoduodenal fistula (CDF). The Iso-Tome® (MTW-Endoskopie W. Haag KG), which is helpful in preventing electrical leakage, has good orientation capabilities and can be easily placed at the orifice of the CDF or ampulla of Vater (AV). We aimed to evaluate the efficacy of endoscopic sphincterotomy (ES) with the Iso-Tome® for cutting the distal PR. Methods: Between May 2003 and July 2012, 35 patients were analyzed retrospectively. The distal PR was cut downward and/or upward using the Iso-tome® until the pink intrapapillary mucosa was fully exposed. Downward incisions were performed from the opening of the CDF to the orifice of the AV; upward incisions were performed in reverse. Results: Spontaneous or artificial CDF occurred in four and 31 patients, respectively. The technical and therapeutic success rates were 94.3% (33/35) and 94.3% (33/35), respectively. There was no case of electrical damage to the pink intrapapillary mucosa. Adverse events occurred in 2.9% (1/35; 1, mild bleeding) of patients. Conclusions: The new technique of ES with the Iso-tome® is feasible and useful for effectively incising the distal PR in patients with CDF and choledocholiths. (
참고문헌 (23)
- Cohen SA, "ERCP and its applications", pp.25~36 (1998), Lippincott-Raven
- Neuhaus H, "ERCP", pp.2008, Saunders
- Testoni PA, "Repeat sphincterotomy: does its safety depend on the interval from the initial procedure?", Am J Gastroenterol, 98, pp.1~3 (2003)
- Sheu BS, "Clinical analysis of choledochoduodenal fistula with cholelithiasis in Taiwan: assessment by endoscopic retrograde cholangiopancreatography", Am J Gastroenterol, 91, pp.122~126 (1996)
- Sriram PV, "The precut: when, where and how? A review", Endoscopy, 35, pp.S24~S30 (2003)
- Park SH, "Pre-cut papillotomy with a new papillotome", Gastrointest Endosc, 62, pp.588~591 (2005)
- Lee TH, "Precut fistulotomy for difficult biliary cannulation: is it a risky preference in relation to the experience of an endoscopist?", Dig Dis Sci, 56, pp.1896~1903 (2011)
- Kim EJ, "Efficacy of needle-knife infundibulotomy in failed cannulation on endoscopic retrograde cholangiopancreatography", Korean J Gastrointest Endosc, 20, pp.267~273 (2000)
- 박상흠, "Feasibility of the Mucosa-Tracking Technique in Precut Papillotomy with the Iso-Tome as an Alternative to the Needle-Knife Technique", Gut and Liver, 4(1), pp.76~83 (2010), 거트앤리버 발행위원회
- Larkin CJ, "Precut sphincterotomy: indications, pitfalls, and complications", Curr Gastroenterol Rep, 3, pp.147~153 (2001)
- Binmoeller KF, "Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation", Gastrointest Endosc, 44, pp.689~695 (1996)
- Cotton PB, "Endoscopic sphincterotomy complications and their management: an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
- Kawai K, "Endoscopic sphincterotomy of the ampulla of Vater", Gastrointest Endosc, 20, pp.148~151 (1974)
- Classen M, "Endoscopic sphincterotomy of the papilla of vater and extraction of stones from the choledochal duct", Dtsch Med Wochenschr, 99, pp.496~497 (1974)
- Park SH, "A new technique of ERCP: Y-shaped endoscopic sphincterotomy (EST) using the isolated-tip sphincterotome in patients with common bile duct (CBD) stones", Gastrointest Endosc, 61, pp.AB216~ (2005)
- Park SH, "Precut papillotomy with isolated-tip needle-knife papillotome", Video J Encycl GI Endosc, 1, pp.523~525 (2013)
- Vandervoort J, "Risk factors for complications after performance of ERCP", Gastrointest Endosc, 56, pp.652~656 (2002)
- Masci E, "Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis", Endoscopy, 35, pp.830~834 (2003)
- Mavrogiannis C, "Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones", Gastrointest Endosc, 50, pp.334~339 (1999)
- Park SY, "Endoscopic large-diameter balloon dilation after fistulotomy for the removal of bile duct stones in a difficult cannulation", Gastrointest Endosc, 69, pp.955~959 (2009)
- Binmoeller KF, "Endoscopic management of bile duct stones", J Clin Gastroenterol, 32, pp.106~118 (2001)
- Stefanidis G, "Endoscopic extraction of large common bile duct stones: a review article", World J Gastrointest Endosc, 4, pp.167~179 (2012)
- Cennamo V, "Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials", Endoscopy, pp.381~388 (2010)