Case series of transpancreatic septotomy as precutting technique for difficult bile duct cannulation
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Kapetanos, D.
Kokozidis, G.
Christodoulou, D.
Mistakidis, K.
Dimakopoulos, K.
Katodritou, E.
Kitis, G.
Tsianos, E. V.
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peer-reviewed
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Endoscopy
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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 naive 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.
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Keywords
Adolescent, Adult, Aged, Aged, 80 and over, *Bile Ducts, Catheterization/*methods, Cholangiopancreatography, Endoscopic Retrograde/adverse effects/*methods, Female, Gastrointestinal Hemorrhage/etiology, Humans, Male, Middle Aged, Pancreas, Pancreatitis/etiology, Retrospective Studies
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http://www.ncbi.nlm.nih.gov/pubmed/17703389
https://www.thieme-connect.de/ejournals/pdf/endoscopy/doi/10.1055/s-2007-966724.pdf
https://www.thieme-connect.de/ejournals/pdf/endoscopy/doi/10.1055/s-2007-966724.pdf
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en
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Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής