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Managing Difficult Cannulations in Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Control Trial Study of Precut Needle Knife Sphincterotomy versus Transpancreatic Sphincterotomy Technique
- Source :
- Siriraj Medical Journal, Vol 71, Iss 3, Pp 175-180 (2019), Siriraj Medical Journal, Vol 71, Iss 3 (2019)
- Publication Year :
- 2019
- Publisher :
- Mahidol University, 2019.
-
Abstract
- Objective: To evaluate the success rate of cannulations and rate of procedure-related complications between needle knife sphincterotomy (NKS) and transpancreatic sphincterotomy (TPS) techniques, and to evaluate the most effective cannulation time to proceed with NKS or TPS. Methods: This study recruited 52 patients with inaccessible bile ducts by the standard cannulation at Khon Kaen Hospital from May 2012 to May 2015. Patients were randomly allocated to the NKS group (N=21) or the TPS group (N=21). Successful cannulations, and complications between NKS and TPS were collected and assessed. Results: Successful cannulations by TPS and NKS were achieved in 14 cases (53.8%) and 13 cases (50%) respectively (p value = 0.781). Post ERCP pancreatitis was found in 2 cases using TPS, and in 3 cases using NKS. There were 3 cholangitis cases in TPS group, and 2 cholangitis cases in NKS group. Perforations were found in 3 cases and 1 case in TPS and NKS group, respectively. There were 4 deaths in this study, one case in TPS group and 3 cases in NKS group. Complications and mortality between TPS and NKS were not statistically significant (P>0.05). After 40 minutes of the ERCPs, there was less chance for a successful cannulation. Unsuccessful cannulations between TPS and NKS was not statistically different according to the Kaplan-Meier analysis. Conclusion: TPS and NKS are able to increase successful cannulations. There are no significant differences in the cannulation success rate and rate of complications between the TPS and NKS. The appropriate time to terminate a cannulation in difficult cases is found to be 40 minutes.
- Subjects :
- Transpancreatic precut sphicterotomy
Medicine (General)
medicine.medical_specialty
law.invention
ERCP
R5-920
Randomized controlled trial
needle knife sphicterotomy
difficult cannulation
time for successful cannulation
law
Transpancreatic
medicine
Needle knife
lcsh:R5-920
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
business.industry
General Medicine
medicine.disease
Endoscopy
Surgery
Pancreatitis
Post ercp pancreatitis
business
lcsh:Medicine (General)
Subjects
Details
- Language :
- English
- ISSN :
- 22288082
- Volume :
- 71
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Siriraj Medical Journal
- Accession number :
- edsair.doi.dedup.....d53f5d1cde092da7ac31d92c2e0e38b9