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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

References

    1. Abu-Hamda EM, Baron TH, Simmons DT, Petersen BT. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. J Clin Gastroenterol. 2005;39:717–721. - PubMed
    1. de Weerth A, Seitz U, Zhong Y, Groth S, Omar S, Papageorgiou C, Bohnacker S, Seewald S, Seifert H, Binmoeller KF, et al. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy. 2006;38:1235–1240. - PubMed
    1. Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005;61:112–125. - PubMed
    1. Sundaralingam P, Masson P, Bourke MJ. Early Precut Sphincterotomy Does Not Increase Risk During Endoscopic Retrograde Cholangiopancreatography in Patients With Difficult Biliary Access: A Meta-analysis of Randomized Controlled Trials. Clin Gastroenterol Hepatol. 2015;13:1722–1729.e2. - PubMed
    1. Mariani A, Di Leo M, Giardullo N, Giussani A, Marini M, Buffoli F, Cipolletta L, Radaelli F, Ravelli P, Lombardi G, et al. Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial. Endoscopy. 2016;48:530–535. - PubMed

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