Combination of Precut Techniques in Difficult Biliary Cannulation

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Techniques

Background:

• Selective biliary cannulation (SBC) is crucial for successful ERCP.
• Standard SBC fails in up to 20% of cases, necessitating precut techniques.
• Needle-knife sphincterotomy (NKS) and transpancreatic septotomy (TPS) are common precut methods, but can also fail.

Purpose of the Study:

• To evaluate the procedural success of a combined TPS + NKS technique for difficult biliary cannulation during ERCP.
• To compare the efficacy of combined precut techniques against individual precut methods.

Main Methods:

• Retrospective analysis of 289 patients undergoing ERCP with precut techniques (2017-2022).
• Patients were grouped into: Transpancreatic septotomy (TPS) only, Needle-knife sphincterotomy (NKS) only, and combined TPS + NKS.
• Evaluated cannulation success rates and ERCP-related adverse effects.

Main Results:

• The TPS + NKS group achieved an 87% SBC success rate, compared to 69% for TPS alone and 75.3% for NKS alone.
• Cannulation success was significantly higher in both NKS and TPS + NKS groups compared to the TPS group (p < 0.001).
• ERCP-related complication rates were similar across all groups.

Conclusions:

• A second precut technique, such as combining TPS and NKS, can be effective when initial precut methods fail.
• Previous TPS does not preclude the successful use of NKS.
• The combined TPS + NKS technique offers an improved success rate for challenging biliary cannulation during ERCP.