Introduction Transpancreatic sphincterotomy (TPS) for difficult common bile duct cannulation during ERCP was first described by Goff in 1995. Since then its safety and efficacy has been debated with some concerns regarding high post ERCP pancreatitis rates (PEP). In published data from recent years PEP can range from 6–20% when TPS is carried out. The majority of TPS is carried out in tertiary referral centres but it is a technique that we have increasingly adopted in our district general hospital when common bile duct cannulation is proving difficult. We wished to review the safety and efficacy of this technique and compare our results to the literature
Methods We reviewed all procedure notes from ERCPs that been had been carried out from October 2011 - October 2013. The reports were reviewed and any cases where transpancretic sphincterotomy was performed were identified. We subsequently reviewed our radiology reporting system, the patients discharge letter and blood results as well as any subsequent hospital admissions to determine any complications. We noted any post ERCP pancreatitis, upper GI bleeding, perforation or death. Complications were classified using the system proposed by Cotton et al. We compared our complication rates to our departments overall complication rates
Results Out of 811 ERCPs carried out in the date range 31 patients were identified who had a transpancreatic sphincterotomy performed. 21 cases (68%) were performed by a consultant whilst 10 cases (32%) were performed by a senior registrar. Successful CBD cannulation was achieved in 25 patients (80%) and in the 6 that failed it was subsequently successful at a later date in 4 patients. Our complication rates are shown in the below table
Conclusion Our results show that transpancreatict sphincterotomy can be carried out at a district general hospital with similar levels of success and complications as reported in the literature from tertiary centres worldwide. In such a small data set a single patient death can bias the results and on reviewing the notes the patient died from a perforation due to a common bile duct stent migrating into the duodenal wall. We concluded this was not related to the technique of PDS and should not deter us from continuing this practice. As expected our complication rates are higher that our units normal complication rates which reflects the challenging nature of the cases when PDS is attempted.
Disclosure of Interest None Declared.
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