Case series of transpancreatic septotomy as precutting technique for difficult bile duct cannulation.

BACKGROUND AND STUDY AIMS: Transpancreatic septotomy can be used instead of other precut techniques to facilitate bile duct cannulation after multiple failed attempts. Within the framework of a prospective randomized study on pentoxifylline, precut cases were retrospectively analyzed. PATIENTS AND METHODS: Of 320 endoscopic retrograde cholangiopancreatographies (ERCPs) in 306 patients with various indications who had a naïve papilla, 34 cases of transpancreatic septotomy were identified and compared with 15 needle-knife sphincterotomies; six patients had received both techniques for bile duct access. Complications were defined according to consensus criteria. RESULTS: In the 55 patients in whom precutting techniques were employed, the use of both techniques alone or in combination resulted in a final common bile duct cannulation rate of 81.8%. Five patients developed complications (9.1%). Of the two cases of pancreatitis (3.6%), one was mild and one severe (combined group). Of the three cases with hemorrhage, one was mild (transpancreatic septotomy) and two severe (needle knife). In patients who underwent conventional pull-type sphincterotomy (n = 242), 6.2% developed complications (nine pancreatitis and six hemorrhage). CONCLUSION: In cases of difficult bile duct cannulation, transpancreatic septotomy seems to be a safe alternative to needle-knife precutting with reasonable success rates. It should be studied in prospective randomized trials.

Comparison of sucralfate and ranitidine twice daily in duodenal ulcer treatment: a multicenter randomized double-blind study.

Sucralfate and ranitidine were compared in the treatment of duodenal ulcer in this multicenter, randomized, double-blind study. A total of 165 patients with endoscopically proven duodenal ulceration were included in the trial and randomized to treatment with sucralfate, 2 g b.i.d. (morning and evening with an empty stomach), or ranitidine, 150 mg twice daily. All patients were endoscopically examined after 4 and, if unhealed, 8 weeks. Of the patients considered suitable for analysis at 4 weeks, 73.5% (61 of 83) of the sucralfate group demonstrated healing of the ulcer in comparison with 63.3% (50 of 79) of the ranitidine group. At 8 weeks cumulative healing rates were 89% (74 of 83) and 84.8% (67 of 79), respectively. When smokers were considered separately, healing rates at 4 weeks were 69.2% (36 of 52) for sucralfate and 53.3% (24 of 45) for ranitidine. At 8 weeks cumulative healing rates were 92.3% (48 of 52) and 77.7% (35 of 45), respectively (p less than 0.05). Overall, there was no difference in the two groups regarding symptom relief and side effects. These results suggest that these drugs are equally effective in the short-term treatment of duodenal ulcer, although in smokers sucralfate appears to be more effective than ranitidine.

Sucralfate and ranitidine twice daily in the treatment of gastric ulcer. A multicenter randomized double-blind study.

Sucralfate and ranitidine were compared in the treatment of gastric ulcer (GU) in this multicenter randomized double-blind study. Sixty-four patients with endoscopically diagnosed GU initially included in the trial were randomly assigned to treatment with sucralfate, 2 g b.i.d. (morning and evening on an empty stomach), or ranitidine, 150 mg b.i.d. Nine patients were subsequently excluded for various reasons. The remaining 55 were examined endoscopically after 4 and, if unhealed, 8 weeks. At 4 weeks, 54.2% (13 of 24) of the sucralfate group had a healed ulcer, in comparison to 45.2% (14 of 31) of the ranitidine group (NS). At 8 weeks, cumulative healing rates were 87.5% (21 of 24) and 84% (26 of 31), respectively (NS). No differences were found in the healing effects of the drugs on smokers and nonsmokers or in side effects. These results suggest that both drugs are equally effective in the short-term treatment of GU.