Modified transprepancreatic septotomy reduces postoperative complications after intractable biliary access

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Innovation

Background:

• Difficult bile duct cannulation is a challenge in endoscopic retrograde cholangiopancreatography (ERCP).
• Transprepancreatic septotomy is an established technique for managing these challenging cases.
• Optimizing procedural safety and efficacy remains a key objective in ERCP.

Purpose of the Study:

• To evaluate the clinical utility of transprepancreatic septotomy with an indwelling guide wire versus a pancreatic duct stent for intractable bile duct cannulation in ERCP.
• To compare the success rates and postoperative complication profiles of these two septotomy techniques.

Main Methods:

• A retrospective analysis of 81 patients with difficult bile duct cannulation during ERCP.
• Patients were divided into two groups: standard transprepancreatic septotomy (37 cases) and modified transprepancreatic septotomy with a pancreatic duct stent (44 cases).
• Cannulation success rates and postoperative complications, including acute pancreatitis, bleeding, and biliary tract infection, were compared.

Main Results:

• Successful bile duct cannulation was achieved in 77 patients (95.1%).
• Cannulation success rates were high in both groups (91.89% for standard septotomy, 97.73% for modified septotomy) with no significant difference (P=.489).
• The modified septotomy group demonstrated a significantly lower incidence of acute pancreatitis (2.33% vs. 20.59%, P=.026) compared to the standard septotomy group.

Conclusions:

• Transprepancreatic septotomy with a pancreatic duct stent is a safe and feasible approach for difficult bile duct cannulation in ERCP.
• The modified technique offers a significant reduction in the rate of post-procedural acute pancreatitis.
• This approach represents a valuable refinement for improving ERCP outcomes in challenging cases.