Journal
CLINICS AND RESEARCH IN HEPATOLOGY AND GASTROENTEROLOGY
Volume 43, Issue 4, Pages 365-372Publisher
ELSEVIER MASSON, CORPORATION OFFICE
DOI: 10.1016/j.clinre.2018.09.004
Keywords
Difficult cannulation; Surgically altered anatomy; ERCP complication; Post-ERCP pancreatitis; Pre-cut; Needle-knife; Balloon-assisted endoscopy; Cap-assisted endoscopy; Laparoendoscopic rendezvous; ERCP; PTCD
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Selective bile duct cannulation is the prerequisite for all endoscopic biliary therapeutic interventions, but this cannot always be achieved easily. Despite advances and new developments in endoscopic accessories, selective biliary access fails in 5%-15% of cases, even in expert high volume centers. Various techniques - such as double-guidewire induced cannulation, pre-cut papillotomy or transpancreatic sphincterotomy with or without placement of a pancreatic stent - have been used to improve cannulation success rates. Repeated and prolonged attempts at cannulation increase the risk of pancreatitis. Repeating the ERCP within a few days after initial failed pre-cut is a successful strategy and should be tried before contemplating more invasive, alternative interventions such as percutaneous-endoscopic or endoscopic ultrasound guided rendezvous procedure, percutaneous transhepatic or surgical intervention. However, standard guidelines or sequential protocol has not been existed up to now. In certain circumstances, there are unique clinical indications for which invasive, alternative interventions should be preferred. We present and discuss the methods that can be used in difficult or failed initial ERCP, therefore to provide practical advice for endoscopists, especially those who are inexperienced. (C) 2018 Elsevier Masson SAS. All rights reserved.
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