Evidence-Based Treatment for A Patient with Difficult Selective Biliary Cannulation during ERCP_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Fengyuan ¹ ,  CHEN Shiyao ²

1. Department of Gastroenterology, Shanghai Fifth Hospital, Fudan University, Shanghai 200240, China;2. Evidenced-based Medicine Center of Fudan University, Shanghai 200032, China;

Corresponding author：

CHEN Shiyao, Email: syaochen@163.com

Keywords：

Endoscopic retrograde cholangiopancreatography; Catheterization; Clinical evidence

DOI：

10.7507/1672-2531.20100593

Video：

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Objective 　To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice.
Methods 　Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded.
Results 　After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting.
Conclusion 　The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.

Citation： CHEN Fengyuan,CHEN Shiyao. Evidence-Based Treatment for A Patient with Difficult Selective Biliary Cannulation during ERCP. Chinese Journal of Evidence-Based Medicine, 2010, 10(11): 1345-1349. doi: 10.7507/1672-2531.20100593 Copy

1.	9 Kaffes AJ, Sriram PV, Rao GV, et al. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc, 2005, 62(5): 669-674.
2.	McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg, 1968, 167(5): 752-756.
3.	Deng DH, Zuo HM, Wang JF, et al. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation. World J Gastroenterol, 2007, 13(32): 4385-4390.
4.	Masci E, Mariani A, Curioni S, et al. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta analysis. Endoscopy, 2003, 35(10): 830-834.
5.	Tang SJ, Haber GB, Kortan P, et al. Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy, 2005, 37(1): 58-65.
6.	Zhou PH, Yao LQ, Xu MD, et al. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int, 2006, 5(4): 590-594.
7.	Maeda S, Hayashi H, Hosokawa O, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy, 2003, 35(9): 721-724.
8.	鲁临, 曾宪忠, 陈健, 等. 两种技术在ERCP选择性胆管插管困难时的对照研究. 中华消化内镜杂志, 2008, 25(2): 73-76.
9.	Catalano MF, Linder JD, Geenen JE. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: Comparison with standard pre-cut papillotomy. Gastrointest Endosc, 2004, 60(4): 557-561.
10.	ASGE standards of practice committee. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy, 2005, 62(1): 1-8.
11.	ASGE standards of practice committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointestinal Endoscopy, 2010, 71(1): 1-9.
12.	Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis: a meta-analysis of controlled trials. Gastrointestinal Endoscopy, 2004, 60(4): 544-550.
13.	Das A, Singh P, Sivak MV, et al. Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointestinal Endoscopy, 2007, 65(7): 960-968.
14.	Laasch HU, Tringali A, Wilbraham L, et al. Comparison of standard and steerable catheters for bile duct cannulation in ERCP. Endoscopy, 2003, 35(8): 669-674.
15.	de Weerth A, Seitz U, Zhong Y, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy, 2006, 38(12): 1235-1240.
16.	Halttunen J, Keränen I, Udd M, et al. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc, 2009, 23(4): 745-749.
17.	Mavrogiannis C, Liatsos C, Romanos A, et al. Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc, 1999, 50(3): 334-339.
18.	Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy, 1997, 29(2): 82-85.
19.	Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla. Clin Gastroenterol Hepatol, 2007, 5(9): 1113-1118.
20.	Kei Ito, Naotaka Fujita, Yutaka Noda, et al. Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol, 2008, 14(36): 5595-5600.
21.	Fogel EL, Sherman S, Lehman GA. Increased selective biliary cannulation rates in the setting of periampullary diverticula: main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. Gastrointest Endosc, 1998, 47(5): 396-400.
22.	Goldberg E, Titus M, Haluszka O, et al. Pancreatic-duct stent placement facilitates difficult common bile duct cannulation. Gastrointest Endosc, 2005, 62(4): 592-596.
23.	Abu-Hamda EM, Baron TH, Simmons DT, et al. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. Clin Gastroenterol, 2005, 39(8): 717-721.
24.	Espinel DJ, Vivas AS, Munoz NF, et al. Needle-knife sphincterotomy for biliary access: a prospective study. Gastroenterol Hepatol, 2005, 28(7): 369-374.
25.	Baillie J. Needle knife sphincterotomy revisited. Gastrointest Endosc, 1997, 46(3): 282-284.
26.	Hashiba K, D’Assuncao MA, Armellini S, et al. Endoscopic suprapapillary blunt dissection of the distal common bile duct in cases of difficult cannulation: a pilot series. Endoscopy, 2004, 36(4): 317-321.
27.	Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc, 1995, 41(5): 502-506.
28.	Slivka A. A new technique to assist in bile duct cannulation.Gastrointest Endosc, 1996, 44(5): 636.
29.	Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy, 1998, 30(7): S80 .
30.	Christoforidis E, Goulimaris I, Kanellos I, et al. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy, 2002, 34(4): 286-292.

1. 9 Kaffes AJ, Sriram PV, Rao GV, et al. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc, 2005, 62(5): 669-674.
2. McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of Vater: a preliminary report. Ann Surg, 1968, 167(5): 752-756.
3. Deng DH, Zuo HM, Wang JF, et al. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation. World J Gastroenterol, 2007, 13(32): 4385-4390.
4. Masci E, Mariani A, Curioni S, et al. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta analysis. Endoscopy, 2003, 35(10): 830-834.
5. Tang SJ, Haber GB, Kortan P, et al. Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy, 2005, 37(1): 58-65.
6. Zhou PH, Yao LQ, Xu MD, et al. Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int, 2006, 5(4): 590-594.
7. Maeda S, Hayashi H, Hosokawa O, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy, 2003, 35(9): 721-724.
8. 鲁临, 曾宪忠, 陈健, 等. 两种技术在ERCP选择性胆管插管困难时的对照研究. 中华消化内镜杂志, 2008, 25(2): 73-76.
9. Catalano MF, Linder JD, Geenen JE. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: Comparison with standard pre-cut papillotomy. Gastrointest Endosc, 2004, 60(4): 557-561.
10. ASGE standards of practice committee. ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. Gastrointestinal Endoscopy, 2005, 62(1): 1-8.
11. ASGE standards of practice committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointestinal Endoscopy, 2010, 71(1): 1-9.
12. Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis: a meta-analysis of controlled trials. Gastrointestinal Endoscopy, 2004, 60(4): 544-550.
13. Das A, Singh P, Sivak MV, et al. Pancreatic-stent placement for prevention of post-ERCP pancreatitis: a cost-effectiveness analysis. Gastrointestinal Endoscopy, 2007, 65(7): 960-968.
14. Laasch HU, Tringali A, Wilbraham L, et al. Comparison of standard and steerable catheters for bile duct cannulation in ERCP. Endoscopy, 2003, 35(8): 669-674.
15. de Weerth A, Seitz U, Zhong Y, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy, 2006, 38(12): 1235-1240.
16. Halttunen J, Keränen I, Udd M, et al. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc, 2009, 23(4): 745-749.
17. Mavrogiannis C, Liatsos C, Romanos A, et al. Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc, 1999, 50(3): 334-339.
18. Kim MH, Lee SK, Lee MH, et al. Endoscopic retrograde cholangiopancreatography and needle-knife sphincterotomy in patients with Billroth II gastrectomy: a comparative study of the forward-viewing endoscope and the side-viewing duodenoscope. Endoscopy, 1997, 29(2): 82-85.
19. Horiuchi A, Nakayama Y, Kajiyama M, et al. Effect of precut sphincterotomy on biliary cannulation based on the characteristics of the major duodenal papilla. Clin Gastroenterol Hepatol, 2007, 5(9): 1113-1118.
20. Kei Ito, Naotaka Fujita, Yutaka Noda, et al. Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol, 2008, 14(36): 5595-5600.
21. Fogel EL, Sherman S, Lehman GA. Increased selective biliary cannulation rates in the setting of periampullary diverticula: main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy. Gastrointest Endosc, 1998, 47(5): 396-400.
22. Goldberg E, Titus M, Haluszka O, et al. Pancreatic-duct stent placement facilitates difficult common bile duct cannulation. Gastrointest Endosc, 2005, 62(4): 592-596.
23. Abu-Hamda EM, Baron TH, Simmons DT, et al. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. Clin Gastroenterol, 2005, 39(8): 717-721.
24. Espinel DJ, Vivas AS, Munoz NF, et al. Needle-knife sphincterotomy for biliary access: a prospective study. Gastroenterol Hepatol, 2005, 28(7): 369-374.
25. Baillie J. Needle knife sphincterotomy revisited. Gastrointest Endosc, 1997, 46(3): 282-284.
26. Hashiba K, D’Assuncao MA, Armellini S, et al. Endoscopic suprapapillary blunt dissection of the distal common bile duct in cases of difficult cannulation: a pilot series. Endoscopy, 2004, 36(4): 317-321.
27. Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc, 1995, 41(5): 502-506.
28. Slivka A. A new technique to assist in bile duct cannulation.Gastrointest Endosc, 1996, 44(5): 636.
29. Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy, 1998, 30(7): S80 .
30. Christoforidis E, Goulimaris I, Kanellos I, et al. Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy, 2002, 34(4): 286-292.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Treatment for A Patient with Difficult Selective Biliary Cannulation during ERCP

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