RESUMO
Cannulation fails in up to 10 % of all endoscopic retrograde cholangiopancreatographies (ERCPs). A standard sphincterotome can be converted to a needle knife to perform precut sphincterotomy (PCS). In this retrospective study, we analyzed cannulation rates, adverse events, and the percentage of patients requiring a second sphincterotome using a converted needle knife. Over a 7-year period, 3322 ERCPs were performed by one experienced therapeutic endoscopist; 1487 sphincterotomies were performed, 78 precut sphincterotomies using a converted needle knife. Successful cannulation using the converted needle knife was achieved in 96 % of cases at the initial procedure. Adverse events occurred in 17 % and post-ERCP pancreatitis was reported in 10 % of patients. A second sphincterotome was needed in 13 % of cases. This study shows a converted needle knife can be used for successful cannulation of either the biliary or the pancreatic duct after a failed cannulation with a standard sphincterotome, with a low percentage of adverse events anda reduction in the need for accessories.
Assuntos
Doenças dos Ductos Biliares/cirurgia , Perda Sanguínea Cirúrgica , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica , Pancreatite/etiologia , Esfinterotomia Endoscópica , Instrumentos Cirúrgicos/tendências , Adulto , Idoso , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Doenças dos Ductos Biliares/patologia , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Cateterismo/efeitos adversos , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/métodos , Constrição Patológica , Duodenoscópios/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Esfinterotomia Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/instrumentação , Esfinterotomia Endoscópica/métodos , Resultado do TratamentoRESUMO
In addition to technological advancements, engagement and collaboration among the wider community of stakeholders will be beneficial toward reducing the risk of infection from reprocessed duodenoscopes. Such a community can raise awareness of the importance of duodenoscope cleaning, work to improve reprocessing training, identify the most pressing unanswered questions that merit further research, and develop tools that can be used by health care facilities to improve the quality of reprocessing at their sites. The Food and Drug Administration looks forward to working with the community to further reduce the risk of infections from reprocessed duodenoscopes.