Jukka Palm1, Arto Saarela, Jyrki Mäkelä. 1. Department of Gastrointestinal Surgery, Oulu University Hospital, Finland. Jukka.Palm@oulu.fi
Abstract
GOALS AND BACKGROUND: There is controversy about the ideal utilization of precut papillotomy in endoscopic retrograde cholangiopancreatography examinations. Almost all reports in the literature concentrate on needle knife precut papillotomy, reporting a wide range of complications. We have used Erlangen precut papillotomy in our institution and our aim was to compare the safety of Erlangen precut papillotomy to standard free cannulation technique. The influence of precutting on the deep biliary cannulation rate was also recorded. STUDY: Over a period of 48 months a total of 602 out of 1044 consecutive endoscopic retrograde cholangiopancreatography examinations fulfilled the inclusion criteria. Patients with an intact papilla who required biliary cannulation were screened. The cohort was divided into a nonprecut group (n=481) and a precut group (n=121). The standard technique included free biliary cannulation with a tapered-tip cannula. An Erlangen type papillotome was used for precutting. Complications, success rate of cannulation, and hyperamylasemia were recorded. RESULTS: Complication rates were similar in the 2 groups (nonprecut 7.1% vs. precut 8.3%, P=0.7). Hyperamylasemia was more common in the precut group (13.3% vs. 31.3%, P<0.001). The final deep biliary cannulation rate after precut papillotomy in cases with problematic cannulation was 98.2%. CONCLUSIONS: Erlangen precut papillotomy results in a high deep biliary cannulation rate with no increased risk of complications when compared to cannulation using standard techniques.
GOALS AND BACKGROUND: There is controversy about the ideal utilization of precut papillotomy in endoscopic retrograde cholangiopancreatography examinations. Almost all reports in the literature concentrate on needle knife precut papillotomy, reporting a wide range of complications. We have used Erlangen precut papillotomy in our institution and our aim was to compare the safety of Erlangen precut papillotomy to standard free cannulation technique. The influence of precutting on the deep biliary cannulation rate was also recorded. STUDY: Over a period of 48 months a total of 602 out of 1044 consecutive endoscopic retrograde cholangiopancreatography examinations fulfilled the inclusion criteria. Patients with an intact papilla who required biliary cannulation were screened. The cohort was divided into a nonprecut group (n=481) and a precut group (n=121). The standard technique included free biliary cannulation with a tapered-tip cannula. An Erlangen type papillotome was used for precutting. Complications, success rate of cannulation, and hyperamylasemia were recorded. RESULTS: Complication rates were similar in the 2 groups (nonprecut 7.1% vs. precut 8.3%, P=0.7). Hyperamylasemia was more common in the precut group (13.3% vs. 31.3%, P<0.001). The final deep biliary cannulation rate after precut papillotomy in cases with problematic cannulation was 98.2%. CONCLUSIONS: Erlangen precut papillotomy results in a high deep biliary cannulation rate with no increased risk of complications when compared to cannulation using standard techniques.