Gastroenterologia y hepatologia · 2006
[Access to the biliary tract through trans-pancreatic sphincterotomy].
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Espinel-Díez J
Аннотация
OBJECTIVE: Several pre-cut procedures have been used in patients with inaccessible bile ducts. Trans-pancreatic sphincterotomy (TS) has been demonstrated to be a valid, but little used technique. We describe our experience with TS with a prospective analysis of its results.
PATIENTS AND METHODS: Twenty patients who underwent TS due to the impossibility of cannulating the biliary tract using routine methods between November 2004 and October 2005 were included. CT-25 sphincteromes (Cook) were used, introducing the tip into the common bile duct or pancreatic duct, performing the cut toward the bile duct, and sectioning the roof of the common bile duct.
RESULTS: We performed 298 ERCP, 176 sphincterotomies and 20 TS (11.3% of sphincterotomies). Cannulation was achieved in 90% of the patients overall and immediate cannulation was achieved in 85%. The percentage of complications was 15% and none were severe. There were no cases of post-ERCP pancreatitis or mortality due to complications.
CONCLUSIONS: TS is an effective technique in gaining immediate access to the biliary tract in a high percentage of patients when access cannot be obtained using routine methods. The risk of complications in not higher than that of other pre-cut techniques.
PATIENTS AND METHODS: Twenty patients who underwent TS due to the impossibility of cannulating the biliary tract using routine methods between November 2004 and October 2005 were included. CT-25 sphincteromes (Cook) were used, introducing the tip into the common bile duct or pancreatic duct, performing the cut toward the bile duct, and sectioning the roof of the common bile duct.
RESULTS: We performed 298 ERCP, 176 sphincterotomies and 20 TS (11.3% of sphincterotomies). Cannulation was achieved in 90% of the patients overall and immediate cannulation was achieved in 85%. The percentage of complications was 15% and none were severe. There were no cases of post-ERCP pancreatitis or mortality due to complications.
CONCLUSIONS: TS is an effective technique in gaining immediate access to the biliary tract in a high percentage of patients when access cannot be obtained using routine methods. The risk of complications in not higher than that of other pre-cut techniques.