Percutaneous transhepatic assistance for duodenoscopic sphincterotomy

Area of Science:

• Gastroenterology
• Interventional Radiology

Background:

• Duodenoscopic sphincterotomy is standard for bile duct stones and papillary stenosis.
• Challenges arise with large peri-papillary diverticula or post-Billroth II gastrectomy.
• Surgery is often the alternative for patients unsuitable for or refusing standard endoscopic procedures.

Purpose of the Study:

• To evaluate a combined radiologist-endoscopist technique for challenging duodenoscopic sphincterotomies.
• To assess the feasibility and safety of percutaneous transhepatic guidewire insertion to aid sphincterotome placement.

Main Methods:

• A collaborative approach involving percutaneous transhepatic guidewire insertion through the papilla.
• Optional balloon dilatation to facilitate subsequent endoscopist-guided sphincterotome insertion.
• Performed in patients where standard duodenoscopic sphincterotomy was not feasible.

Main Results:

• Successful sphincterotomy was achieved in 10 out of 11 attempted patients.
• The combined approach facilitated sphincterotome insertion in difficult cases.
• No significant complications were reported during the procedures.

Conclusions:

• The combined radiologist-endoscopist technique is a viable and safe option for difficult duodenoscopic sphincterotomies.
• This minimally invasive approach can be an effective alternative to surgery for select patients.
• It expands therapeutic options for managing common bile duct stones and papillary stenosis in challenging anatomies.