Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography
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Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes). Conclusions: Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.
Abstract
Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes). Conclusions: Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.
참고문헌 (22)
- Bailey AA, "A prospective randomized trial of cannulation technique in ERCP : effects on technical success and post-ERCP pancreatitis", Endoscopy, 40, pp.296~301 (2008)
- Freeman ML, "ERCP cannulation : a review of reported techniques", Gastrointest Endosc, 61, pp.112~125 (2005)
- Larkin CJ, "Precut sphincterotomy : indications, pitfalls, and complications", Curr Gastroenterol Rep, 3, pp.147~153 (2001)
- Williams EJ, "Are we meeting the standards set for endoscopy? : results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice", Gut, 56, pp.821~829 (2007)
- Cheng CL, "Risk factors for post-ERCP pancreatitis : a prospective multicenter study", Am J Gastroenterol, 101, pp.139~147 (2006)
- Dumonceau JM, "Prophylaxis of post-ERCP pancreatitis : European Society of Gastrointestinal Endoscopy(ESGE)guideline : updated June 2014", Endoscopy, 46, pp.799~815 (2014)
- Freeman ML, "Risk factors for post-ERCP pancreatitis : a prospective, multicenter study", Gastrointest Endosc, 54, pp.425~434 (2001)
- Loperfido S, "Major early complications from diagnostic and therapeutic ERCP : a prospective multicenter study", Gastrointest Endosc, 48, pp.1~10 (1998)
- Masci E, "Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography : a meta-analysis", Endoscopy, 35, pp.830~834 (2003)
- Masci E, "Complications of diagnostic and therapeutic ERCP : a prospective multicenter study", Am J Gastroenterol, 96, pp.417~423 (2001)
- Testoni PA, "Risk factors for post-ERCP pancreatitis in high-and low-volume centers and among expert and non-expert operators : a prospective multicenter study", Am J Gastroenterol, 105, pp.1753~1761 (2010)
- Wang P, "Risk factors for ERCP-related complications : a prospective multicenter study", Am J Gastroenterol, 104, pp.31~40 (2009)
- Kaffes AJ, "Early institution of pre-cutting for difficult biliary cannulation : a prospective study comparing conventional vs. a modified technique", Gastrointest Endosc, 62, pp.669~674 (2005)
- Mariani A, "Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis : a randomized trial", Endoscopy, 48, pp.530~535 (2016)
- Testoni PA, "Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease", Dig Liver Dis, 43, pp.792~796 (2011)
- Choudhary A, "Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis : a systematic review and meta-analysis", World J Gastroenterol, 20, pp.4093~4101 (2014)
- Jang SI, "Primary needle-knife fistulotomy versus conventional cannulation method in a high-risk cohort of post-endoscopic retrograde cholangiopancreatography pancreatitis", Am J Gastroenterol, 115, pp.616~624 (2020)
- Jin YJ, "Utility of needle-knife fistulotomy as an initial method of biliary cannulation to prevent post-ERCP pancreatitis in a highly selected at-risk group : a single-arm prospective feasibility study", Gastrointest Endosc, 84, pp.808~813 (2016)
- 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)
- Cotton PB, "Endoscopic sphincterotomy complications and their management : an attempt at consensus", Gastrointest Endosc, 37, pp.383~393 (1991)
- Freeman ML, "Complications of endoscopic biliary sphincterotomy", N Engl J Med, 335, pp.909~918 (1996)
- Sherman S, "Complications of endoscopic sphincterotomy : a prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts", Gastroenterology, 101, pp.1068~1075 (1991)