Increased selective biliary cannulation rates in the setting of periampullary diverticula

Main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy

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Abstract

Background: Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access. Methods: Among 4138 ERCPs, there were 246 cases (5.9%) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3%), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a pancreatic duct stent. Needle- knife sphincterotomy was then performed followed by attempts to achieve biliary access. Results: Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5%). Two patients developed post-ERCP pancreatitis. Conclusions: When the papilla is within the periampullary diverticulum, placement of a main pancreatic duct stent keeps the papilla out of the diverticulum, thereby facilitating pre- cut needle-knife sphincterotomy and selective biliary cannulation.

Original languageEnglish
Pages (from-to)396-400
Number of pages5
JournalGastrointestinal Endoscopy
Volume47
Issue number5
DOIs
StatePublished - 1998

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Pancreatic Ducts
Diverticulum
Catheterization
Stents
Endoscopic Retrograde Cholangiopancreatography
Needles
Pancreatitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{17ceb244c67e4f4fbade581fac547176,
title = "Increased selective biliary cannulation rates in the setting of periampullary diverticula: Main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy",
abstract = "Background: Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access. Methods: Among 4138 ERCPs, there were 246 cases (5.9{\%}) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3{\%}), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a pancreatic duct stent. Needle- knife sphincterotomy was then performed followed by attempts to achieve biliary access. Results: Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5{\%}). Two patients developed post-ERCP pancreatitis. Conclusions: When the papilla is within the periampullary diverticulum, placement of a main pancreatic duct stent keeps the papilla out of the diverticulum, thereby facilitating pre- cut needle-knife sphincterotomy and selective biliary cannulation.",
author = "Evan Fogel and Stuart Sherman and Glen Lehman",
year = "1998",
doi = "10.1016/S0016-5107(98)70226-3",
language = "English",
volume = "47",
pages = "396--400",
journal = "Gastrointestinal Endoscopy",
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publisher = "Mosby Inc.",
number = "5",

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TY - JOUR

T1 - Increased selective biliary cannulation rates in the setting of periampullary diverticula

T2 - Main pancreatic duct stent placement followed by pre-cut biliary sphincterotomy

AU - Fogel, Evan

AU - Sherman, Stuart

AU - Lehman, Glen

PY - 1998

Y1 - 1998

N2 - Background: Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access. Methods: Among 4138 ERCPs, there were 246 cases (5.9%) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3%), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a pancreatic duct stent. Needle- knife sphincterotomy was then performed followed by attempts to achieve biliary access. Results: Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5%). Two patients developed post-ERCP pancreatitis. Conclusions: When the papilla is within the periampullary diverticulum, placement of a main pancreatic duct stent keeps the papilla out of the diverticulum, thereby facilitating pre- cut needle-knife sphincterotomy and selective biliary cannulation.

AB - Background: Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access. Methods: Among 4138 ERCPs, there were 246 cases (5.9%) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3%), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a pancreatic duct stent. Needle- knife sphincterotomy was then performed followed by attempts to achieve biliary access. Results: Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5%). Two patients developed post-ERCP pancreatitis. Conclusions: When the papilla is within the periampullary diverticulum, placement of a main pancreatic duct stent keeps the papilla out of the diverticulum, thereby facilitating pre- cut needle-knife sphincterotomy and selective biliary cannulation.

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