Endoscopic suprapapillary blunt dissection of the distal common bile duct in cases of difficult cannulation: a pilot series.

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  • Additional Information
    • Source:
      Publisher: Georg Thieme Verlag Country of Publication: Germany NLM ID: 0215166 Publication Model: Print Cited Medium: Print ISSN: 0013-726X (Print) Linking ISSN: 0013726X NLM ISO Abbreviation: Endoscopy Subsets: MEDLINE
    • Publication Information:
      Publication: Stuttgart : Georg Thieme Verlag
      Original Publication: Stuttgart, Thieme.
    • Subject Terms:
      Ampulla of Vater/*surgery ; Biliary Tract Diseases/*surgery ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Sphincterotomy, Endoscopic/*methods; Adult ; Aged ; Aged, 80 and over ; Catheterization/methods ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Common Bile Duct/surgery ; Dissection/methods ; Electrocoagulation ; Female ; Humans ; Middle Aged ; Pilot Projects ; Postoperative Complications ; Safety ; Treatment Outcome
    • Abstract:
      Background and Study Aims: There is no consensus about the optimal alternative procedure in cases of failed cannulation of the common bile duct (CBD). The alternatives are usually considered to be high-risk procedures. This study describes endoscopic dissection of the distal biliary tract (EDBT) as a new technique in cases of difficult cannulation of the CBD.
      Patients and Methods: Out of a total of 1057 patients in whom cannulation was attempted, deep cannulation failed in 49 patients, and 48 of those underwent EDBT. The procedure consists of cutting the mucosa, and the partial isolation of the distal part of the biliary tract using catheters, a needle-knife papillotome, and thin forceps. Access to the biliary tract was achieved with an endoscopic needle or forceps with or without electrocoagulation.
      Results: EDBT was successful in all cases. In 46 patients EDBT was followed by standard sphincterotomy. Four patients developed clinical pancreatitis and hyperamylasemia occurred in 11 cases. Perforation, uncontrolled bleeding, and other complications did not occur in this series.
      Conclusions: EDBT is feasible, safe and constitutes a potential alternative for cannulation of the CBD. The endoscopic visualization of the wall structure and duodenal layers during the maneuvers at the papilla probably accounts for the absence of major complications.
    • Publication Date:
      Date Created: 20040402 Date Completed: 20040727 Latest Revision: 20061115
    • Publication Date:
      20231215
    • Accession Number:
      10.1055/s-2004-814410
    • Accession Number:
      15057681