Papillary fistulotomy vs conventional cannulation for endoscopic biliary access: A prospective randomized trial

Carlos Kiyoshi Furuya, Paulo Sakai, Fabio Ramalho Tavares Marinho, Jose Pinhata Otoch, Spencer Cheng, Lívia Lemes Prudencio, Eduardo Guimarães Hourneaux de Moura, Everson Luiz de Almeida Artifon, Carlos Kiyoshi Furuya, Paulo Sakai, Fabio Ramalho Tavares Marinho, Jose Pinhata Otoch, Spencer Cheng, Lívia Lemes Prudencio, Eduardo Guimarães Hourneaux de Moura, Everson Luiz de Almeida Artifon

Abstract

Aim: To compare the cannulation success, biochemical profile, and complications of the papillary fistulotomy technique vs catheter and guidewire standard access.

Methods: From July 2010 to May 2017, patients were prospectively randomized into two groups: Cannulation with a catheter and guidewire (Group I) and papillary fistulotomy (Group II). Amylase, lipase and C-reactive protein at T0, as well as 12 h and 24 h after endoscopic retrograde cholangiopancreatography, and complications (pancreatitis, bleeding, perforation) were recorded.

Results: We included 102 patients (66 females and 36 males, mean age 59.11 ± 18.7 years). Group I and Group II had 51 patients each. The successful cannulation rates were 76.5% and 100%, respectively (P = 0.0002). Twelve patients (23.5%) in Group I had a difficult cannulation and underwent fistulotomy, which led to successful secondary biliary access (Failure Group). The complication rate was 13.7% (2 perforations and 5 mild pancreatitis) vs 2.0% (1 patient with perforation and pancreatitis) in Groups I and II, respectively (P = 0.0597).

Conclusion: Papillary fistulotomy was more effective than guidewire cannulation, and it was associated with a lower profile of amylase and lipase. Complications were similar in both groups.

Keywords: Catheterization; Common bile duct; Complications; Endoscopic retrograde cholangiopancreatography; Therapeutic use.

Conflict of interest statement

Conflict-of-interest statement: All authors declare no potential conflicting interests related to this paper.

Figures

Figure 1
Figure 1
Schematic sequence of papillary fistulotomy. A and B: Dissection of the major papilla; C: Sphincterotome in the bile duct; D: Radiological image.
Figure 2
Figure 2
Sequence of papillary fistulotomy. A and B: Dissection of the major papilla; D: Sphincterotome in the bile duct; D: Radiological image.
Figure 3
Figure 3
Flowchart showing the sequence of procedures performed in the study.
Figure 4
Figure 4
Amylase profile after the procedure.
Figure 5
Figure 5
Lipase profile for the two groups.
Figure 6
Figure 6
Evolution of C-reactive protein.

References

    1. Abu-Hamda EM, Baron TH, Simmons DT, Petersen BT. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. J Clin Gastroenterol. 2005;39:717–721.
    1. de Weerth A, Seitz U, Zhong Y, Groth S, Omar S, Papageorgiou C, Bohnacker S, Seewald S, Seifert H, Binmoeller KF, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy. 2006;38:1235–1240.
    1. Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005;61:112–125.
    1. Sundaralingam P, Masson P, Bourke MJ. Early Precut Sphincterotomy Does Not Increase Risk During Endoscopic Retrograde Cholangiopancreatography in Patients With Difficult Biliary Access: A Meta-analysis of Randomized Controlled Trials. Clin Gastroenterol Hepatol. 2015;13:1722–1729.e2.
    1. Mariani A, Di Leo M, Giardullo N, Giussani A, Marini M, Buffoli F, Cipolletta L, Radaelli F, Ravelli P, Lombardi G, et al. Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial. Endoscopy. 2016;48:530–535.
    1. Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996;335:909–918.
    1. Mavrogiannis C, Liatsos C, Romanos A, Petoumenos C, Nakos A, Karvountzis G. Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc. 1999;50:334–339.
    1. Zhou W, Li Y, Zhang Q, Li X, Meng W, Zhang L, Zhang H, Zhu K, Zhu X. Risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis: a retrospective analysis of 7,168 cases. Pancreatology. 2011;11:399–405.
    1. Osnes M, Kahrs T. Endoscopic choledochoduodenostomy for choledocholithiasis through choledochoduodenal fistula. Endoscopy. 1977;9:162–165.
    1. Sakai P, Artifon ELA, Maluf Filho F. Fistulopapilotomia Endoscópica: Uma Alternativa à Papila de Difícil Cateterização. GED. 2001;20:208–212.
    1. Lerch MM. Classifying an unpredictable disease: the revised Atlanta classification of acute pancreatitis. Gut. 2013;62:2–3.
    1. Kirkwood B, JAC S. Essential Medical Statistics. 2nd ed. Massachusetts, United States: Blackwell Science;; 2006.
    1. Cheng CL, Sherman S, Watkins JL, Barnett J, Freeman M, Geenen J, Ryan M, Parker H, Frakes JT, Fogel EL, et al. Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006;101:139–147.
    1. Bailey AA, Bourke MJ, Williams SJ, Walsh PR, Murray MA, Lee EY, Kwan V, Lynch PM. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy. 2008;40:296–301.
    1. Bailey AA, Bourke MJ, Kaffes AJ, Byth K, Lee EY, Williams SJ. Needle-knife sphincterotomy: factors predicting its use and the relationship with post-ERCP pancreatitis (with video) Gastrointest Endosc. 2010;71:266–271.
    1. Halttunen J, Keränen I, Udd M, Kylänpää L. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc. 2009;23:745–749.
    1. O'Connor HJ, Bhutta AS, Redmond PL, Carruthers DA. Suprapapillary fistulosphincterotomy at ERCP: a prospective study. Endoscopy. 1997;29:266–270.
    1. Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc. 2001;54:425–434.
    1. Halttunen J, Meisner S, Aabakken L, Arnelo U, Grönroos J, Hauge T, Kleveland PM, Nordblad Schmidt P, Saarela A, Swahn F, et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol. 2014;49:752–758.
    1. Laasch HU, Tringali A, Wilbraham L, Marriott A, England RE, Mutignani M, Perri V, Costamagna G, Martin DF. Comparison of standard and steerable catheters for bile duct cannulation in ERCP. Endoscopy. 2003;35:669–674.
    1. Lella F, Bagnolo F, Colombo E, Bonassi U. A simple way of avoiding post-ERCP pancreatitis. Gastrointest Endosc. 2004;59:830–834.
    1. Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc. 2000;52:387–391.
    1. Artifon EL, Sakai P, Cunha JE, Halwan B, Ishioka S, Kumar A. Guidewire cannulation reduces risk of post-ERCP pancreatitis and facilitates bile duct cannulation. Am J Gastroenterol. 2007;102:2147–2153.
    1. Zhou PH, Yao LQ, Xu MD, Zhong YS, Gao WD, He GJ, Zhang YQ, Chen WF, Qin XY. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int. 2006;5:590–594.
    1. Adler DG, Lieb JG 2nd, Cohen J, Pike IM, Park WG, Rizk MK, Sawhney MS, Scheiman JM, Shaheen NJ, Sherman S, Wani S. Quality indicators for ERCP. Gastrointest Endosc. 2015;81:54–66.
    1. Khatibian M, Sotoudehmanesh R, Ali-Asgari A, Movahedi Z, Kolahdoozan S. Needle-knife fistulotomy versus standard method for cannulation of common bile duct: a randomized controlled trial. Arch Iran Med. 2008;11:16–20.
    1. Jin YJ, Jeong S, Lee DH. Utility of needle-knife fistulotomy as an initial method of biliary cannulation to prevent post-ERCP pancreatitis in a highly selected at-risk group: a single-arm prospective feasibility study. Gastrointest Endosc. 2016;84:808–813.
    1. Ayoubi M, Sansoè G, Leone N, Castellino F. Comparison between needle-knife fistulotomy and standard cannulation in ERCP. World J Gastrointest Endosc. 2012;4:398–404.
    1. Tanaka R, Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Tsuji S, Ishii K, Ikeuchi N, Umeda J, et al. Is the double-guidewire technique superior to the pancreatic duct guidewire technique in cases of pancreatic duct opacification? J Gastroenterol Hepatol. 2013;28:1787–1793.
    1. Nishino T, Toki F, Oyama H, Shiratori K. More accurate prediction of post-ercp pancreatitis by 4-h serum lipase levels than amylase levels. Dig Endosc. 2008;20:169–177.
    1. Dumonceau JM, Devière J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy. 1998;30:S80.
    1. Testoni PA, Testoni S, Giussani A. Difficult biliary cannulation during ERCP: how to facilitate biliary access and minimize the risk of post-ERCP pancreatitis. Dig Liver Dis. 2011;43:596–603.
    1. Zagalsky D, Guidi MA, Curvale C, Lasa J, de Maria J, Ianniccillo H, Hwang HJ, Matano R. Early precut is as efficient as pancreatic stent in preventing post-ERCP pancreatitis in high-risk subjects - A randomized study. Rev Esp Enferm Dig. 2016;108:258–562.
    1. Cennamo V, Fuccio L, Zagari RM, Eusebi LH, Ceroni L, Laterza L, Fabbri C, Bazzoli F. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy. 2010;42:381–388.
    1. Huibregtse K, Katon RM, Tytgat GN. Precut papillotomy via fine-needle knife papillotome: a safe and effective technique. Gastrointest Endosc. 1986;32:403–405.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj