TRANSPANCREATIC BILIARY SPHINCTEROTOMY (TPBS), THE EXPERIENCE OF A GREEK ERCP CENTER

Aims Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP) when CBD cannulation is difficult according to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines. The effectiveness of this procedure is still unclear. We studied the efficacy of this technique, the possible complications, and the demographic characteristics of our patients.

Methods Our study included 18 patients that underwent ERCP with one wire-guided cannulation (WGC) performed in Ioannina University Hospital between July and November of 2021 ( Among 300 ERCP ). We studied the demographic characteristics, their indications, the success rate of catheterization, and the prevalence of side effects.

Results 18 patients of which 55% (n=10) were women and 45% (n=8) men, underwent TPBS-WGC because of difficult biliary access. In terms of indication, 27.7% (n=5) was attributed to pancreatic tumor/cancer, 16.6% (n=3) cholangiocarcinoma, 38.8% (n=7) CBD stone and 16.6% (n=3) biliary pancreatitis. Deep bile duct access was achieved in all patients (100%) with this technique. Post-ERCP mild pancreatitis (PEP) developed in one patient (5,6%) and post-ERCP bleeding presented in one patient (5,6%) who was receiving antiplatelet agent. 66.6% (n=12) underwent biliary stent placemen and 100% (n=18) pancreatic stent placement for PEP prophylaxis.

Conclusions TPBS is a useful rescue method in cases of difficult cannulation, accompanied by an acceptable complication rate. Compared to other cannulation techniques, TPBS is a feasible, safe, and relatively inexpensive process. However, no follow-up studies are available for TPBS. Therefore, such studies are needed for its full evaluation.

Publication History

Article published online:
14 April 2022