Endoscopy 2019; 51(04): S76
DOI: 10.1055/s-0039-1681393
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ERCP cannulation 1 Panorama Hall
Georg Thieme Verlag KG Stuttgart · New York

INITIAL EXPERIENCES WITH TRANSPANCREATIC SPHINCTEROTOMY IN HUNGARIAN CENTERS BASED ON PROSPECTIVELY COLLECTED REGISTRY DATA

S Gódi
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
,
D Pécsi
2   Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
,
P Hegyi
2   Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
,
L Czakó
3   First Department of Medicine, University of Szeged, Szeged, Hungary
,
T Gyökeres
4   Department of Gastroenterology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
,
F Pakodi
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
,
Á Patai
5   Department of Gastroenterology, Markusovszky Teaching Hospital, Szombathely, Hungary
,
Z Szepes
3   First Department of Medicine, University of Szeged, Szeged, Hungary
,
Á Vincze
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Medical School, Pécs, Hungary
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Transpancreatic sphincterotomy (TPS) might be an alternative in cases of inadvertent pancreatic duct (PD) cannulation. We evaluated the efficacy and safety of TPS in comparison to needle-knife precut (NKP) techniques from a prospective database with the analysis of post-ERCP pancreatitis (PEP) prophylaxis measures.

Methods:

The Hungarian ERCP Registry contains 1164 cases with native papilla from five tertiary centers. TPS was performed in 44 cases (3.8%) as a primary advanced cannulation and in 7 cases (0.6%) after NKP resulted pancreatic access, while NKP was used in 250 cases (21.5%).

Results:

Successful biliary cannulation was achieved in 97.7% (43/44, p = 0.01) of the cases after TPS, while only in 28.6% (2/7, p < 0.001) if NKP preceded TPS, and in 83.6% (209/250) after NKP. PEP occurred in 4.5% (2/44) of cases after TPS, in 14.3% (1/7) if precutting preceded TPS, while in 4.4% (11/250) after NKP. Prophylactic pancreatic stent (PPS) after TPS and postprocedural indomethacin suppository (IND) were applied in 41.2% (21/51), while PPS without IND in 17.6% (9/51) of cases. Only IND was given in 17.6% (9/51), while no PEP prophylaxis was applied in 22.7% (12/51) of cases. Moderately severe PEP occurred in a patient (8.3%, 1/12) without PEP prophylaxis, while one mild PEP after IND (11.1%, 1/9) and another mild PEP after PPS (11.1%, 1/9). Clinically significant bleeding was observed in 2 cases (3.9%) after TPS, while in 4 cases (1.6%) after NKP.

Conclusions:

TPS is a valuable technique to gain biliary access in cases of difficult biliary cannulation. The rate of biliary access with TPS is significantly higher in our cohort than with conventional precutting. A preceding precut before TPS however significantly decreases the chances of biliary access. Our data shows comparable safety of TPS to NKP methods, even with suboptimal PEP prophylaxis. Stricter adherence to PEP prophylaxis guidelines is warranted.