Burdick's Technique for Biliary Access Revisited

Abstract

The precut sphincterotomy is used to facilitate selective biliary access in cases of difficult biliary cannulation. Needle-knife precut papillotomy is the standard of care but is associated with a high rate of complications such as pancreatitis, duodenal perforation, bleeding, etc. Sometimes during bowing of the sphincterotome/cannula and the use of guide wire to facilitate biliary cannulation, inadvertent formation of a false passage occurs in the 10 to 11 o'clock direction. Use of this step to access the bile duct by the intramucosal incision technique was first described by Burdick et al., and since then two more studies have also substantiated the safety and efficacy of this non-needle type of precut sphincterotomy. In this review, we discuss this non-needle technique of precut sphincterotomy and also share our experience using this "Burdick's technique."

Keywords: Burdick's technique; Intramucosal incision technique; Needle knife sphincterotomy; Precut sphincterotomy.

Fig. 1

(A) Formation of false tract. (B) Incision of false tract. (C) Selective biliary cannulation.

Fig. 2

(A) Schematic diagram showing sphincter mucosal bridge. (B) Schematic diagram showing incision of mucosal bridge.