title: Biliary drainage by endoscopic choledochoduodenal fistulotomy in patients with papillary carcinoma.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Gil Medical Center, Gachon Medical School, Inchon, South Korea.
authors.forename: Jong Jae
authors.initials: JJ
authors.lastname: Park
authors.forename: Sun Suk
authors.initials: SS
authors.lastname: Kim
authors.forename: You Kyung
authors.initials: YK
authors.lastname: Kim
authors.forename: Moon Ki
authors.initials: MK
authors.lastname: Jung
authors.forename: Hyun Chul
authors.initials: HC
authors.lastname: Park
authors.forename: Ju Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Jae Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Jin Hai
authors.initials: JH
authors.lastname: Hyun
mesh_terms: 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