A new guidewire cannulation technique in ERCP: successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist.
Summary of "A new guidewire cannulation technique in ERCP: successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist."
BACKGROUND:
Current studies have addressed ways to improve the success of selective biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP). The objective of this study was to assess the efficacy of deep bile duct access using a short-wire system with sphincterotome and guidewire controlled only by the endoscopist.
METHODS:
This was a prospective study of 70 patients with biliary diseases subjected to ERCP. Biliary cannulation was performed by the endoscopist without direct cooperation of the assistant in two centers with different experience in ERCP. The RX Biliary System™ was used in all patients. Efficacy (success rate and time to cannulation) of deep bile duct access and procedure-related complications were determined.
RESULTS:
Overall guidewire cannulation was successful in 65 of 70 patients (92.9%). Nonintentional pancreatic duct cannulation with the guidewire was performed in 22 patients (31.4%). Additional techniques were needed in 18 patients (25.7%): guidewire into the pancreatic duct in 11 patients (15.7%); contrast-medium was used in 13 patients (18.6%); and precut was performed in 3 patients (4.3%). Attempts at papilla cannulation numbered <10 in 48 patients (68.6%), and time to biliary cannulation was <10 min in 42 patients (60%). Minor complications occurred in five patients (7.1%). There were no significant differences between patients in both centers.
CONCLUSIONS:
The short-wire system allows the endoscopist to have access to the bile duct with a high success rate-early and safely-without the direct participation of the assistant.
Affiliation
Gastroenterology Department, Manises Hospital, Universidad Católica de Valencia, C/Roses s/n. 46940 Manises, Valencia, Spain, alopez@hospitalmanises.es.
Journal Details
This article was published in the following journal.
Name: Surgical endoscopy
ISSN: 1432-2218
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21136105
- DOI: http://dx.doi.org/10.1007/s00464-010-1479-y
Medical and Biotech [MESH] Definitions
Cholangiopancreatography, Endoscopic Retrograde
Fiberoptic endoscopy designed for duodenal observation and cannulation of VATER'S AMPULLA, in order to visualize the pancreatic and biliary duct system by retrograde injection of contrast media. Endoscopic (Vater) papillotomy (SPHINCTEROTOMY, ENDOSCOPIC) may be performed during this procedure.
Biliary Fistula
Abnormal passage in any organ of the biliary tract or between biliary organs and other organs.
Circulatory Arrest, Deep Hypothermia Induced
A technique to arrest the flow of blood by lowering BODY TEMPERATURE to about 20 degrees Centigrade, usually achieved by infusing chilled perfusate. The technique provides a bloodless surgical field for complex surgeries.
Cholangitis, Sclerosing
Chronic inflammatory disease of the BILIARY TRACT. It is characterized by fibrosis and hardening of the intrahepatic and extrahepatic biliary ductal systems leading to bile duct strictures, CHOLESTASIS, and eventual BILIARY CIRRHOSIS.
Infusions, Intraosseous
The administration of medication or fluid through a needle directly into the bone marrow. The technique is especially useful in the management of pediatric emergencies when intravenous access to the systemic circulation is difficult.
PubMed Articles
Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center.
BACKGROUND: Even in experienced hands, a common problem with endoscopic retrograde cholangiopancreatography (ERCP) is difficulty reaching a deep biliary cannulation. The most recent alternative method...
Additional Biliary Cannulation Methods in Patients with Juxtapapillary Duodenal Diverticula.
BACKGROUND AND AIMS: Juxtapapillary diverticula (JPD) can increase the difficulty of biliary cannulation. A number of additional methods have been defined in case of failed cannulation attempt by stan...
Difficult Biliary Access for ERCP.
Endoscopic retrograde cholangiopancreatography (ERCP) is a technically-demanding procedure. The ability to selectively cannulate the bile duct and pancreatic duct (PD) quickly and atraumatically is th...
BACKGROUND AND STUDY AIMS: Among cases of difficult biliary cannulation, alternatives include use of a pancreatic duct stent (PDS) or guidewire (PDW) to facilitate access. We compared the effectivenes...
Outcome of Repeat ERCP After Initial Failed Use of a Needle Knife for Biliary Access.
INTRODUCTION: A needle knife is often used to gain bile duct access when standard techniques have failed. If unsuccessful, the next step may involve either radiological- or endos...
Clinical Trials
The purpose of this study is to determine if the double guide wire technique is more effective than the conventional method in those cases of difficult selective biliary cannulation in the...
The Use of Guide Wire in Biliary Cannulation: Angled or Straight Tipped Guide Wire?
The purpose of the study is to prospectively evaluate the deep biliary cannulation in ERCP with the angled tipped guide wire or the straight tipped guide wire.
The primary purpose of this prospective, randomized trial is successful intravenous (IV) cannulation on first attempt with the use of either the Vein Viewer (VV) or standard cannulation me...
1. This study will compare the first attempt success rate of cannulation in research participants randomized to using a new FDA approved AccuVein AV300 device for intravenous ac...
ERCP is a diagnostic and therapeutic procedure that is required in patients with suspected common bile duct stone, malignant biliary obstruction, biliary fistula, etc. Pancreatitis may occ...
