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PTH-020 Transpancreatic sphincterotomy: a valuable technique for gaining cbd access
  1. M Elzubier1,
  2. S Esmaily1,
  3. D Dwarakanath1,
  4. B Chaudhury1,
  5. D Majumdar2,
  6. V Mitra2,
  7. J Hancock1
  1. 1DEPARTMENT OF GASTROENTEROLOGY, North Tees Hospital, Stockton-on-Tees
  2. 2DEPARTMENT OF GASTROENTEROLOGY, James Cook Hospital, Middlesbrough, UK

Abstract

Introduction Transpancreatic Sphincterotomy (TPS) involves wire-guided cannulation of the main pancreatic duct (MPD) followed by standard pull-type sphincterotome cutting towards the main channel. Typically MPD stent insertion follows TPS to prevent post ERCP pancreatitis (PEP). ESGE [1] recommends that in patients with a small papilla that is difficult to cannulate, TPS should be considered if unintentional wire guided MPD cannulation occurs.

A previous study has suggested that TPS maybe as effective as double guide wire (DGW) in achieving biliary cannulation and has a lower PEP rate. [1]

The aim of this study was to review the practice, complications and outcomes of TPS at University Hospital of North Tees.

Method A retrospective review of all ERCP procedures between January 2014 and October 2016. Endoscopy reports, radiology, blood results and discharge letters were reviewed.

Results 1365 ERCP procedures were performed in the study period. Overall CBD cannulation rate was 91.3%. 105/1365 (7.7%) wire guided TPS procedures were carried out. Mean age in the TPS group was 67 years (range: 20–91) - 64/105 (61%) male and 41/105 (39%) females. 3 senior consultants and a senior endoscopic fellow performed TPS. TPS was used as the initial strategy in the event of MPD cannulation and without using alternative methods such as DGW.

ERCP indication in TPS group is shown in chart.

CBD cannulation was achieved in 96/105 (90.5%) of cases - 81/105 (77.1%) during the first ERCP and 15/105 (14.2%) at second ERCP [where CBD cannulation was achieved at second attempt, TPS had been done at the first ERCP]. In 9/105 patients CBD cannulation was not achieved.

8/105 (7.6%) had a complication. 6/105 (5.7%) patients had PEP - 5/6 had a prophylactic MPD stent. 1/105 had a post sphincterotomy bleed which was controlled with endoscopic therapy. 1/105 had a perforation and a subsequent long hospital stay. There were no procedural related deaths.

Conclusion This study demonstrates that TPS is a safe and effective way of gaining CBD access. Our data suggests that experienced operators in a DGH setting can safely carry out TPS. Our study is the second largest cohort in the literature and the largest cohort in the UK. We would suggest early adoption of TPS if wire access to the pancreatic duct is achieved, this will likely reduce complication rate as a result of less engagement with the papilla and overall reduced time at CBD cannulation.

References

  1. . Papillary cannulation and sphincterotomy techniques at ERCP: ESGE Clinical Guideline. Endoscopy. 2016Jul;48(07):657–83.

  2. . Kahaleh M, et al. Prospective evaluation of pancreatic sphincterotomy as a precut technique for biliary cannulation. Clinical Gastroenterology and Hepatology. 2004Nov 30;2(11):971–7

Disclosure of Interest None Declared

  • ERCP (Endoscopic retrograde cholangiopancreatography)
  • Transpancreatic sphincterotomy

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