EFFECTIVENESS AND SAFETY OF TRANSPANCREATIC PAPILLOTOMY: A LARGE SCALE RETROSPECTIVE CROSS-SECTIONAL STUDY

Aims Difficult cannulation represents a common condition during endoscopic retrograde cholangiopancreatography (ERCP). This study assessed the efficacy and adverse events during transpancreatic sphincterotomy (TPS), and investigated confounders associated with those outcomes.

Methods All patients refered to our department for ERCP during 2015-2020 were eligible, in case of intact papilla and visceral anatomy. In addition to standard measures, TPS was combined with pancreatic stent (PS) placement. Beyond demographics, we retrieved data considering indication, peri-ampullary anatomy, necessity for TPS or fistulotomy, their outcomes and complications. x2 test was conducted to investigate associations between TPS and independent variables, and statistical significance was set at p<0.05. When significance was observed, the respective variables were introduced in a regression model.

Results 1082 individual patients were eligible, with equal female:male ratio and mean age of 72.7 (±15.82) years. Seventy-three patients (6.7%) underwent TPS, with a 95.9% success rate. Papilla morphology or regional diverticulum did not affect the decision to TPS, though it was significantly associated with malignant common bile duct (CBD) obstruction as ERCP indication (p=0.001) and followed ineffective fistulotomy in 23% of cases (p<0.001). Considering adverse events, TPS did not increase the incidence of post-ERCP pancreatitis (PEP), whilst affected bleeding (p=0.005). Regression analysis revealed a protective role of TPS on PEP, probably due to PS (RR:0.015, p<0.001), whereas the aforementioned risk of hemorrhage was attributed to previous pre-cut attemts (RR:3.024, p=0.004).

Conclusions TPS combined with PS is an effective and safe modality in cases of difficult cannulation and could be the first choice in malignant CBD obstruction.

Publication History

Article published online:
14 April 2022