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Use of the mini-forceps traction-assisted cannulation technique when standard ERCP methods fail: Single-center
Ankit Mishra1, Charles Meade2, Allison R Schulman2
1Department of Internal Medicine, University of Michigan, Ann Arbor, United States.
Background And Study Aims:
There are few salvage techniques for achieving biliary cannulation when no duct can be accessed.
Patients And Methods:
We retrospectively reviewed 10 consecutive cases in which the mini-forceps traction-assisted cannulation technique (MFTAC) was used after failure of any duct access during endoscopic retrograde cholangiopancreatography (ERCP). Outcomes included technical success, use of adjunct techniques; time to biliary access; and adverse events (AEs).
Results:
Most patients had a native papilla (n = 9) of peri-diverticular location (n = 5) and a benign indication (n = 6). Standard cannulation was unsuccessful over 8:23 mm:ss (interquartile range [IQR] 6:04-19:43). MFTAC had 100% technical success, achieved biliary access after 17:38 mm:ss (IQR 8:52-20:31), and had a 10% incidence of AEs (post-ERCP pancreatitis). MFTAC was sufficient to allow biliary cannulation in three cases and allowed pancreatic duct access in seven cases, which then allowed biliary cannulation with double-wire technique (5/10) and transpancreatic septotomy (2/10).
Conclusions:
MFTAC is a feasible salvage approach for biliary access when standard cannulation methods fail.
