Safety and efficacy of transpancreatic sphincterotomy as first line technique in difficult biliary cannulation

Aims Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation strategy in which the endoscopist uses a sphincterotome to incise the septum between the pancreatic and biliary ducts, providing access to the common bile duct (CBD) when cannulation cannot be done or proves challenging.

Methods This is a retrospective study conducted in endoscopy center at our university hospital, covering the period from January 2024 to October 2024, during which 180 endoscopic retrograde cholangiopancreatographies (ERCP) were performed. All patients had NSAID+hydratation for post ERCP AP. The characteristics were collected through an Excel database and then analyzed using Jamovi software, version 2.4.

Results The number of patients included in our study was 14, representing 7,77% of all ERCPs performed. The median age of the patients was 64,8 (34 -81(years, with a predominance of female (57,2%). Approximately 57,14% of the patients had comorbidities: diabetes (28,5%), hypertension (HTN) (21,4%), smoking (21,4%), alcoholism (14,2%), cholecystectomy (14,2%), heart disease (21,4%), traumatic pathology (28,5%)%, and other conditions (21,4%). The indication for sphincterotomy was divided into either benign pathology (lithiasis=28,5%) or malignant obstruction 71,5% (21,4% proximal structure, 50% distal stenosis). Bile duct dilation was present in 92,8% of cases: 23,07% (0-10 mm), 61,5% (10-20 mm), and 15,3% (greater than 20 mm). Hyperbilirubinemia was observed in 92,8% of patients: 30,7% (0-100 mg/L), 15,3% (100-200 mg/L), and 46,15% greater than 200 mg/L. Regarding the anesthesia technique, 71,5% were under sedation and 28,5% were under general anesthesia. The procedure was successful in 92,8% of cases (76,93% in a single session, 23.07% in two sessions), with a failure rate of 7,2% (representing 1 case). Post-sphincterotomy complications were present in only one case, representing 7,2% (acute pancreatitis).

Conclusions Transpancreatic biliary sphincterotomy as first line technique in difficult biliary cannulation was safe and efficient in 92,8%.Therefore, a large scale study is needed to confirm our results.

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Artikel online veröffentlicht:
27. März 2025