ABSTRACT
INTRODUCCIÓN: la canulación profunda de la via biliar principal es requisito para una Pancreato-colangiografía Retrograda Endoscópica (PCRE) de carácter terapéutico. El pre corte es una técnica practicada en casos de canulación difícil. Objetivo: Reportar los casos de pacientes con canulación difícil y fistulotomia suprapapilar como un método para la canulación selectiva del colédoco. Reportar la eficacia, hallazgos demográficos, endoscópicos y complicaciones de éste procedimiento. MATERIAL Y MÉTODOS: estudio prospectivo, descriptivo y observacional de casos. Se ha realizado en 93 pacientes sometidos a PCRE con canulación difícil en quienes se practicó el pre corte tipo Fistulotomia, en un Centro privado de Endoscopia Digestiva del 2000 al 2010 en Lima. RESULTADOS: En 1205 (100%) CPRE se hicieron 1152 (96%) papiloesfinterotomias, de éstos en 93 casos (8%) casos se hizo fistulotomia previa a la papiloesfinterotomia. El grupo atareo más frecuente fue de 61 a 70 años, la relación F:M, 2.4:1. La eficacia fue 96%, los hallazgos endoscópicos más frecuentes fueron Odditis, impactación de cálculo y la presencia de ampuloma, los diagnósticos finales fueron enfermedad litiásica (34%), seguida de la Odditis con o sin litiasis coledociana (29%), en el 75% de casos se realizó terapéutica, el 8.5% de casos presentó complicaciones (pancreatitis y sangrado). No se registró perforaciones ni colangitis. CONCLUSIONES: en esta serie la fistulotomia en casos de canulación difícil es eficaz, es más frecuente en casos de Odditis, cálculo impactado y ampuloma y las complicaciones son bajas. RECOMENDACIONES: el pre corte tipo fistulotomia está dirigida a pacientes que requieren PCRE terapéutica, la decisión de realizarla debe ser precoz, la firma de un consentimiento informado es primordial.
INTRODUCTION: Biliary conducts deep cannulation is a requirement for therapeutic Endoscopic Retrograde Cholangio-Pancreatography (ERCP). The pre-cut papillotomy is a technique for difficult cannulation cases. Aims: Report cases of hard cannulation and suprapapilar fistulotomy as a method for selective common bile duct cannulation. Report efficacy, demographic and endoscopic findings and complications of this procedure. MATERIALS AND METHODS: Observational, descriptive and prospective study of cases. Sample of 93 patients who had a difficult cannulation ERCP, in which suprapapilar fistulotomy pre-cut type was done, in a private digestive endoscopic center between 2000 and 2010 in Lima, Peru. RESULTS: 1205 (100%) ERCP were made 1152 (96%) papillosphincterotomies. Fistulotomy was done in 93 cases (8%) of these papillosphincterotomies. The most prevalent age group was 61 to 70 years old, the female-male proportion was 2.4:1. The efficacy was 96%. The most prevalent endoscopy findings were odditis, gallstone impactation and ampulloma presence, final diagnosis were lithiasic disease (34%), Odditis with or without common bile duct lithiasis (29%). Therapeutic ERCP was done in 75% of the cases, 8.5% showed complications (pancreatitis and bleeding). No perforation or cholangitis were registered. CONCLUSIONS: In this case series, fistulotomy in difficult cannulation procedures had good efficacy. Is most prevalent in cases with odditis, gallstone impactation and ampulloma. Complications of the procedure are low. RECOMMENDATIONS: The fistulotomy type of pre-cut is leaded for patients who require therapeutic ERCP. The decision for doing the procedure must be precocious and informed consent is primordial.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bile Duct Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Sphincterotomy, Endoscopic/methods , Bile Duct Diseases/diagnosis , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Prospective Studies , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/instrumentation , Treatment OutcomeABSTRACT
INTRODUCTION: Biliary conducts deep cannulation is a requirement for therapeutic Endoscopic Retrograde Cholangio-Pancreatography (ERCP). The pre-cut papillotomy is a technique for difficult cannulation cases. AIMS: Report cases of hard cannulation and suprapapilar fistulotomy as a method for selective common bile duct cannulation. Report efficacy, demographic and endoscopic findings and complications of this procedure. MATERIALS AND METHODS: Observational, descriptive and prospective study of cases. Sample of 93 patients who had a difficult cannulation ERCP, in which suprapapilar fistulotomy pre-cut type was done, in a private digestive endoscopic center between 2000 and 2010 in Lima, Peru. RESULTS: 1205 (100%) ERCP were made 1152 (96%) papillosphincterotomies. Fistulotomy was done in 93 cases (8%) of these papillosphincterotomies. The most prevalent age group was 61 to 70 years old, the female-male proportion was 2.4:1. The efficacy was 96%. The most prevalent endoscopy findings were odditis, gallstone impactation and ampulloma presence, final diagnosis were lithiasic disease (34%), Odditis with or without common bile duct lithiasis (29%). Therapeutic ERCP was done in 75% of the cases, 8.5% showed complications (pancreatitis and bleeding). No perforation or cholangitis were registered. CONCLUSIONS: In this case series, fistulotomy in difficult cannulation procedures had good efficacy. Is most prevalent in cases with odditis, gallstone impactation and ampulloma. Complications of the procedure are low. RECOMMENDATIONS: The fistulotomy type of pre-cut is leaded for patients who require therapeutic ERCP. The decision for doing the procedure must be precocious and informed consent is primordial.
Subject(s)
Bile Duct Diseases/surgery , Cholangiopancreatography, Endoscopic Retrograde/methods , Sphincterotomy, Endoscopic/methods , Adult , Aged , Aged, 80 and over , Bile Duct Diseases/diagnosis , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Female , Humans , Male , Middle Aged , Prospective Studies , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/instrumentation , Treatment OutcomeABSTRACT
INTRODUCTION: diagnostic and therapeutic ERCP in patients with Billroth II gastrectomy is a challenging procedure due to anatomic alterations. New accessories and techniques were developed in order to minimize these adversities. AIM: a new technique for biliary access in patients with Billroth II gastrectomy. PATIENTS: In the period from February 2003 to August 2007, 257 ERCP presented Billroth II gastrectomy and choledocolithiasis. In 37 of these patients catheterization by conventional technique was not possible and they were submitted to the new technique. METHODS: after fistulotomy in order to access CBD, a 0.035-inch guidewire was passed followed by an 8-mm dilator biliary balloon which was settled in transpapillary position. Through the working channel the knedle-knife was passed which when positioned in front of the papilla allowed the section of the sphincter over the balloon inflated with contrast until waist disappearance on radioscopy. RESULTS: of the 37 patients submitted to the new procedure six were excluded. Sixteen patients (61.6%) were female and fifteen (48.4%) male. Age ranged from 29 to 89 years with a mean of 62.3 years. All patients had jaundice by clinical and laboratory tests. Time of procedure varied from 18 to 48 minutes (30 minutes). Diameter of the bile duct was 4.5 to 12.8 mm (7.7 mm) presenting one to seven calculi. There were occurred six (19.3%) complications related to the procedure, three (9.7%) pancreatitis, two (6.4%) hemorrhages and one (3.2%) perforation. There were no procedure-related deaths. CONCLUSION: success of this technique was 83.8% (31 of the 37 cases); therefore the technique is considered a safe and efficient method in patients with Billroth II and difficult duodenal papilla cannulation and it was previously attempted by means of conventional cannulation technique.
Subject(s)
Catheterization/methods , Cholangiopancreatography, Endoscopic Retrograde/methods , Choledocholithiasis/surgery , Common Bile Duct/surgery , Sphincterotomy, Endoscopic/methods , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Choledocholithiasis/diagnosis , Female , Gastroenterostomy/methods , Humans , Male , Middle Aged , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/instrumentation , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate if using a soft-tipped guidewire to cannulate the common bile duct may ameliorate development of post-ERCP pancreatitis and facilitate cannulation of the CBD. DESIGN AND SETTING: A single-center, blinded, randomized trial of conventional cannulation technique using sphinctertome and contrast injection versus guidewire cannulation technique. METHODS: We prospectively randomized 300 patients to conventional cannulation (group I) or guidewire cannulation (group II) technique. OUTCOME MEASURES: Primary outcome measure was incidence of acute pancreatitis and secondary outcome measures were ease of cannulation of common bile duct (assessed by attempts required for common bile duct cannulation & rates of precut sphincterotomy) and overall complication rates. RESULTS: Guidewire cannulation was associated with significantly lower likelihood of post-ERCP pancreatitis (adjusted OR 0.43, 95% CI 0.21-0.89, P= 0.02). Twenty-five patients (16.6%) in group I and thirteen patients (8.6%) in group II developed acute pancreatitis, P= 0.037. All instances of pancreatitis were mild. There were more women in group II; 41 in group I and 59 in group II, P= 0.028. Otherwise the two groups were comparable for age, age under 35 yr, indication for ERCP, diagnosis, and number of patients with SOD. The number of patients requiring 0-3, 4-6, and 7-10 attempts for successful cannulation of the common bile duct were 87, 48, and 15 in group I and 117, 24, and 9 in group II, respectively, P= 0.001. A total of 33 patients in group I and 13 patients in group II required precut sphincterotomy, P= 0.007. Rates of accidental pancreatic duct cannulation were 21 in group I and 27 in group II, P= 0.34. Rates of overall complication were not significantly different in the two groups. CONCLUSIONS: Guidewire technique for bile duct cannulation lowers likelihood of post-ERCP pancreatitis by facilitating cannulation and reducing need for precut sphincterotomy.
Subject(s)
Catheterization/instrumentation , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Common Bile Duct Diseases/diagnosis , Common Bile Duct Diseases/surgery , Pancreatitis/prevention & control , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pancreatitis/etiology , Prospective Studies , Single-Blind Method , Sphincterotomy, Endoscopic/adverse effects , Sphincterotomy, Endoscopic/instrumentationABSTRACT
Se estudiaron y tabularon treinta pacinetes consecutivos a quienes se les practicó inicialmente esfinterotomía endoscópica durante un periodo de dos años, todos con diagnóstico simultáneo de litiasis en el colédoco y vesícula biliar, siendo sometidos posteriormente veintiséis de ellos a colesistectomía por el método laparoscópico. Creemos que es un enfoque lógico por lo menos por ahora en nuestro país, en el manejo de estos enfermos, con menos complicaciones y costos
Subject(s)
Humans , Cholecystectomy, Laparoscopic/instrumentation , Sphincterotomy, Endoscopic/instrumentation , Gallstones/economics , Gallstones/surgeryABSTRACT
We performed needle papillotomy in 26 patients. When the biliary tract was not approach by conventional methods. We used an home made sphincterotomy and begin the incision at the papillar orifice and cut in cephalic direction to the 11-12 o'clock, and stop the cutting when we observe bile flow or choledochus mucosa. The only complication was bleeding in two patients and it stopped with epinephrine injection. There were not perforations or mortality. We conclude that needle papillotomy is a safe and useful method in selected cases.
Subject(s)
Sphincterotomy, Endoscopic/methods , Humans , Needles , Sphincterotomy, Endoscopic/instrumentationSubject(s)
Humans , Postoperative Complications/epidemiology , Sphincterotomy, Endoscopic/adverse effects , Argentina/epidemiology , English Abstract , Follow-Up Studies , Postoperative Complications/mortality , Socioeconomic Factors , Sphincterotomy, Endoscopic/instrumentation , Sphincterotomy, Endoscopic/mortality , Sphincterotomy, Endoscopic/statistics & numerical data , Time FactorsSubject(s)
Humans , Comparative Study , Postoperative Complications/epidemiology , Sphincterotomy, Endoscopic/adverse effects , Argentina/epidemiology , English Abstract , Follow-Up Studies , Postoperative Complications/mortality , Socioeconomic Factors , Sphincterotomy, Endoscopic/instrumentation , Sphincterotomy, Endoscopic/mortality , Sphincterotomy, Endoscopic/statistics & numerical data , Time FactorsABSTRACT
Between April 1981 and April 1991, there were 547 EPT performed, seventy-five of which had in situ gall bladder. They were performed in two groups, who were similar from the technical-anatomical point of view, and sociocultural background. The early morbidity showed 31 complications (5.6%). The most frequent ones were:perforation in 8 cases and haemorrhage in 5. Medical treatment, which included the endoscopic technique in 20 cases (3.7%) and surgical procedures in 11 cases (2.0%) was used. The mortality rate was 1.8% (10 cases), perforation (4) and cholecystitis (3) being the main causes. There were three deaths (0.5%) not related to the method. The morbimortality was not significantly increased by the complementary methods. After analysing the complications related to the cause of EPT performance, it was observed that they were more frequently produced in choledochal stones: 20 (3.6%), followed by choledochal and gall bladder stones: 7 (1.3%). However the mortality was 0.7% in the former and 0.5% in the latter. The morbimortality of the last two years is compared to that of the preceding ones. The follow-up was done in 114 (20.8%) of the cases with a marked difference between the high sociocultural group (76 cases) and the low one (36). Eighteen pathological cases were found (3.3%). The treatment of each complication in long term is shown.
Subject(s)
Postoperative Complications/epidemiology , Sphincterotomy, Endoscopic/adverse effects , Argentina/epidemiology , Follow-Up Studies , Humans , Postoperative Complications/mortality , Socioeconomic Factors , Sphincterotomy, Endoscopic/instrumentation , Sphincterotomy, Endoscopic/mortality , Sphincterotomy, Endoscopic/statistics & numerical data , Time FactorsABSTRACT
Endoscopic sphincterotomy is one of the more effective therapeutic procedures for the management of some biliary tree abnormalities. In choledocolitiasis, a 90% succesfull rate has been obtained. Complications include bleeding, perforation, cholangitis, and pancreatitis. Mortality rates between 1.0 to 1.3% are informed. Contraindications are the same as for panendoscopy as well as the presence of stones greater than 2.5 cms. In giant stones, some other endoscopic approaches can be used, including mechanical lithotripsy, chemical treatment, electrohydraulic shockwaves, laser and biliary stent application. Endoscopic sphincterotomy is also indicated as an adjuvant therapy previous to extracorporeal lithotripsy.