Intramural incision technique: a useful and safe procedure for obtaining ductal access during ERCP
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Sri Prakash Misra1, Manisha Dwivedi
1Department of Gastroenterology, Moti Lal Nehru Medical College, University of Allahabad, Allahabad, India.
Background:
Intramucosal incision technique is a useful procedure to achieve ductal access in patients undergoing ERCP. However, the procedure has been underused.
Objective:
Our purpose was to evaluate the efficacy and safety of the intramucosal incision technique and to compare it with standard precut needle-knife papillotomy.
Setting:
A large teaching hospital.
Patients:
Patients undergoing endoscopic sphincterotomy.
Interventions:
If a complete or an incomplete false tract formed during probing for the biliary ductal system, the intramucosal incision technique was attempted. Needle-knife precut papillotomy was performed in those in whom bile duct access could not be obtained even after 4 attempts at cannulating the bile duct.
Main Outcome Measurements:
The success rate and complications of the intramucosal incision technique were compared with those for kneedle-knife papillotomy.
Results:
The intramucosal incision technique was attempted in 23 patients and was successful in 22. A definitive procedure could be performed in all 22 patients, and mild pancreatitis developed in only one of them (4.5%). During the same period, needle-knife papillotomy was attempted in 169 patients. Biliary access was gained in 159 (94%) patients. Complications occurred in 14 (8.2%) patients (mild pancreatitis in 6, moderate pancreatitis in 2, bleeding requiring endoscopic therapy in 5, and perforation in 1 patient).
Limitations:
Single center study.
Conclusions:
Intramucosal incision technique is a very useful and safe procedure and should be performed if a false tract has formed during probing for ductal access during ERCP.
