Biliary drainage by endoscopic choledochoduodenal fistulotomy in patients with papillary carcinoma.
BACKGROUND
There are few reports of endoscopic choledochoduodenal fistulotomy (endoscopic fistulotomy) in patients with papillary carcinoma by using a needle-knife.


METHODS
Among 35 patients with papillary carcinoma requiring biliary drainage, 14 with a suprapapillary bulge underwent endoscopic fistulotomy alone or with widening of the fistula by using a standard sphincterotome or dilation balloon catheter.


METHODS
Transfistula bile duct cannulation was successful on the first attempt in 13 of 14 patients (93%) and temporary biliary drainage through the fistula was successfully established in all 13 patients. The single complication was minor bleeding (7%) in 1 patient. In 6 patients with biliary obstruction who were not operative candidates, endoscopic fistulotomy was used for palliation, and all remained asymptomatic for a mean period of 3.2 months.


CONCLUSIONS
Endoscopic fistulotomy is an effective, relatively safe biliary drainage procedure. It should be considered in selected patients with bile duct obstruction caused by papillary carcinoma and a suprapapillary bulge caused by the dilated bile duct.
Park
Jong Jae
JJ
Department of Internal Medicine, Gil Medical Center, Gachon Medical School, Inchon, South Korea.
Kim
Sun Suk
SS
Kim
You Kyung
YK
Jung
Moon Ki
MK
Park
Hyun Chul
HC
Kim
Ju Hyun
JH
Kim
Jae Sun
JS
Hyun
Jin Hai
JH
D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001658:Biliary Fistula / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D002768:Choledochostomy / Q000379:methods*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies