2021 TDDW
Section：Pancreas / Biliary
⑯
TRANSPANCREATIC SPHINECTEROTOMY IS EFFECTIVE AND SAFE PROCEDURE IN DIFFICULT BILIARY ACCESS: A RETROSPECTIVE STUDY IN A SOUTHERN TAIWAN MEDICAL CENTER Fai-Meng Sou, Yi-Chun Chiu, Lung-Sheng Lu, Cheng-Kun Wu, Chung-Mou Kuo, Chih-Ming Liang Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
經胰括約肌切開術在困難膽道進接的 病人是安全既有效的：南台灣教學醫院 的回朔性研究 蘇輝明 邱逸群 盧龍生 吳鎮琨 郭仲謀 梁志明 高雄長庚紀念醫院胃腸肝膽科系
received TPS. The mean age was 63.8 years old. 43 patients (36.8%) received ERCP due to bile duct stone, 27 patients (23.1%) were liver-related malignancy, 9 patients (7.7%) were pancreatic malignancy. There was no difference in biliary cannulation successful rate between NKP and TPS groups (75% vs. 64.7%, p = 0.383), TPS group had higher percentage in receiving more than 5 cannulation attempts (70.6% vs. 37%, p = 0.016) and more than 1 pancreatic attempt (94.1% vs. 55%, p = 0.002) than the NKP group. TPS group had more patients who received rectal NSAID for post-ERCP pancreatitis (PEP) (70.6% vs. 39%, p = 0.019). There was no difference in cannulation time (17 min vs. 22.2 min, p = 0.249) and procedure time (32 min vs 36 min, p = 0.358) between NKP and TPS groups. Total 10 (8.5%) patients complicated with PEP, 5 (4.27%) patients with bleeding, 2 (1.7%) patients with perforation. There were no significant differences in complication rates between the two groups. Conclusions: Both NKP and TPS had acceptable cannulation rate and complication rate in patients with difficult cannulation.
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is used for diagnosing and treating pancreatobiliary disease. ESGE suggested guidewire-assisted cannulation for patients with naïve papilla, but about 10-20% of patients failed to achieve biliary cannulation 2. Different techniques were developed for difficult cannulation, including transpancreatic sphincterotomy (TPS), double guidewire technique, needle knife papillotomy (NKP), and needle knife fistulotomy (NKF). Little data was found to compare the efficacy and complications inTPS. Aims: Compared the CBD cannulation rates and complications between standard NKP and TPS. Methods: A total of 1904 patients received ERCP between Jan 2018 and Feb 2021. There were 1129 naïve papilla. 171 (15.1%) cases with difficult biliary cannulation (cannulation time >10 mins) treated with endoscopic papillotomy. Patients who received NKP and TPS were enrolled in this study after excluding the patients who had successful cannulation using traditional guidewire-assisted cannulation (n = 958) or NKF techniques (n = 54). Results: Among 117 patients enrolled in this study, 100 patients received NKP and 17 patients
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