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Randomized Controlled Trial
. 2018 Apr 28;24(16):1803-1811.
doi: 10.3748/wjg.v24.i16.1803.

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

Carlos Kiyoshi Furuya  1 , Paulo Sakai  2 , Fabio Ramalho Tavares Marinho  2 , Jose Pinhata Otoch  3 , Spencer Cheng  2 , Lívia Lemes Prudencio  3 , Eduardo Guimarães Hourneaux de Moura  2 , Everson Luiz de Almeida Artifon  4
Affiliations
Randomized Controlled Trial

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

Carlos Kiyoshi Furuya et al. World J Gastroenterol. .

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.

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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.
See this image and copyright information in PMC

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