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KMID : 1038120230560040490
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Clinical Endoscopy
2023 Volume.56 No. 4 p.490 ~ p.498
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Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography
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Yasuhiro Kuraishi
Kazuo Hara
Shin Haba
Takamichi Kuwahara
Nozomi Okuno
Takafumi Yanaidani
Sho Ishikawa
Tsukasa Yasuda
Masanori Yamada
Nobumasa Mizuno
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Abstract
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Background/Aims : Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique.
Methods : One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated.
Results : The median size of the papillary roof was 6 mm (range, 3?20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3?15 minutes).
Conclusions : Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.
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KEYWORD
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Biliary cannulation, Endoscopic retrograde cholangiopancreatography, Needle knife fistulotomy, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Precut
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