EFFICACY AND SAFETY OF A NEW ENDOSCOPIC BILIARY ACCESS TECHNIQUE

Aims Biliary cannulation is a challenging and time expensive technique during endoscopic retrograde cholangiopancreatography (ERCP), as it may fail in about 20% of cases. Several alternatives to conventional method of sphincterotome and guidewire have been proposed to date, although occur not negligible adverse events in such cases. Our primary endpoint was to assess the effectiveness and safety of deep common bile duct (CBD) cannulation after a new pre-cut with “short-incision” of papilla (fistulotomy-like). The secondary endpoint was to estimate the complication’s rate and the procedural time.

Methods From June to October 2019 we prospectively enrolled 33 consecutive subjects with naïve papilla, undergoing ERCP for obstruction of the CBD. When the first attempt of biliary access failed using the guidewire-assisted technique, we performed an early “short-incision” of papilla. Then we carried out a rapid deep biliary cannulation followed by selective contrast agent injection.

Results The majority of our patients underwent ERCP for choledocholithiasis (63.6%) and in sometimes it was placed a stent at the end of procedure, as well as in cases of pancreatic cancer (24.2%) or papilla fibrosis (6.1%) (Table 1). A one-attempt effective cannulation of the CBP was gained in 60.6% (20/33) of subjects, using the standard technique. Whereas, in 39.4% (13/33) of patients undergoing ‘short-incision’ of papilla, a selective access of CBP was obtained in 36.6 ± 14.2 seconds. The overall procedural time did not significantly differ, as compared to the standard ERCP (p = 0.53). Three cases were complicated by self-limiting intra-procedural hemorrhage, and only one case by post-ERCP pancreatitis. They were reported in the first group. No intra-procedural or late complications occurred in the second group.

Conclusions The cannulation of the CBD during ERCP, using an early ‘short-incision’ of the papilla could be an effective and reasonably safe technique. Further randomized trials are needed to confirm these results.