Sri Prakash Misra1, Manisha Dwivedi. 1. Department of Gastroenterology, Moti Lal Nehru Medical College, University of Allahabad, Allahabad, India.
Abstract
BACKGROUND: Intramucosal incision technique is a useful procedure to achieve ductal access in patients undergoing ERCP. However, the procedure has been underused. OBJECTIVE: Our purpose was to evaluate the efficacy and safety of the intramucosal incision technique and to compare it with standard precut needle-knife papillotomy. SETTING: A large teaching hospital. PATIENTS: Patients undergoing endoscopic sphincterotomy. INTERVENTIONS: If a complete or an incomplete false tract formed during probing for the biliary ductal system, the intramucosal incision technique was attempted. Needle-knife precut papillotomy was performed in those in whom bile duct access could not be obtained even after 4 attempts at cannulating the bile duct. MAIN OUTCOME MEASUREMENTS: The success rate and complications of the intramucosal incision technique were compared with those for kneedle-knife papillotomy. RESULTS: The intramucosal incision technique was attempted in 23 patients and was successful in 22. A definitive procedure could be performed in all 22 patients, and mild pancreatitis developed in only one of them (4.5%). During the same period, needle-knife papillotomy was attempted in 169 patients. Biliary access was gained in 159 (94%) patients. Complications occurred in 14 (8.2%) patients (mild pancreatitis in 6, moderate pancreatitis in 2, bleeding requiring endoscopic therapy in 5, and perforation in 1 patient). LIMITATIONS: Single center study. CONCLUSIONS: Intramucosal incision technique is a very useful and safe procedure and should be performed if a false tract has formed during probing for ductal access during ERCP.
BACKGROUND: Intramucosal incision technique is a useful procedure to achieve ductal access in patients undergoing ERCP. However, the procedure has been underused. OBJECTIVE: Our purpose was to evaluate the efficacy and safety of the intramucosal incision technique and to compare it with standard precut needle-knife papillotomy. SETTING: A large teaching hospital. PATIENTS: Patients undergoing endoscopic sphincterotomy. INTERVENTIONS: If a complete or an incomplete false tract formed during probing for the biliary ductal system, the intramucosal incision technique was attempted. Needle-knife precut papillotomy was performed in those in whom bile duct access could not be obtained even after 4 attempts at cannulating the bile duct. MAIN OUTCOME MEASUREMENTS: The success rate and complications of the intramucosal incision technique were compared with those for kneedle-knife papillotomy. RESULTS: The intramucosal incision technique was attempted in 23 patients and was successful in 22. A definitive procedure could be performed in all 22 patients, and mild pancreatitis developed in only one of them (4.5%). During the same period, needle-knife papillotomy was attempted in 169 patients. Biliary access was gained in 159 (94%) patients. Complications occurred in 14 (8.2%) patients (mild pancreatitis in 6, moderate pancreatitis in 2, bleeding requiring endoscopic therapy in 5, and perforation in 1 patient). LIMITATIONS: Single center study. CONCLUSIONS: Intramucosal incision technique is a very useful and safe procedure and should be performed if a false tract has formed during probing for ductal access during ERCP.