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Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Abstract

DE-LA-MORENA-MADRIGAL, Emilio-J.; RODRIGUEZ-GARCIA, M.ª-Isabel; GALERA-RODENAS, Ana-Belén  and  PEREZ-ARELLANO, Elena. Biliary cannulation effectiveness and pancreatitis risk using two early precut techniques. Rev. esp. enferm. dig. [online]. 2018, vol.110, n.2, pp.74-81. ISSN 1130-0108.  http://dx.doi.org/10.17235/reed.2017.5175/2017.

Introduction:

Precut techniques allow for successful biliary cannulation rates approaching 100% but there may be an associated increase in the risk of complications. Recently, early needle-knife precut has been shown to be a safe procedure and is now used as a pancreatitis prevention resource for difficult cannulation cases. The goal of the present study was to assess cannulation and pancreatitis rates using two early precut techniques.

Patients and methods:

This was a retrospective study of endoscopic retrograde cholangio-pancreatography (ERCP) procedures performed from 2013 to 2016. The efficacy and safety of simple cannulation, needle-knife precut and transpancreatic precut were assessed.

Results:

Simple cannulation was achieved in 369 (73.4%) of 503 evaluable ERCP procedures. Needle-knife precut was successful in 51 (96.2%) of 53 attempts and transpancreatic precut was successful in 75 (96.2%) of 78 attempts. The overall cannulation rate was 98.4%. There were eleven (2.4%) pancreatitis events, six (1.8%) with simple cannulation (two severe, one fatal), five (6.3%) with transpancreatic precut (two severe) and zero events with the needle-knife precut procedure. Among the patients undergoing the precut procedure, seven experienced perforations (two severe) and there were seven bleeding events. The overall complication rate was 14.4%.

Conclusions:

The complementary use of either precut technique provides a satisfactory biliary cannulation rate. However, the rates of pancreatitis and other severe complications are higher for transpancreatic versus needle-knife precut, therefore the indications for both techniques should be modified.

Keywords : ERCP; Biliary cannulation; Needle-knife precut; Transpancreatic precut; Post-ERCP pancreatitis.

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