[Access to the biliary tract through trans-pancreatic sphincterotomy].
OBJECTIVE
Several pre-cut procedures have been used in patients with inaccessible bile ducts. Trans-pancreatic sphincterotomy (TS) has been demonstrated to be a valid, but little used technique. We describe our experience with TS with a prospective analysis of its results.


METHODS
Twenty patients who underwent TS due to the impossibility of cannulating the biliary tract using routine methods between November 2004 and October 2005 were included. CT-25 sphincteromes (Cook) were used, introducing the tip into the common bile duct or pancreatic duct, performing the cut toward the bile duct, and sectioning the roof of the common bile duct.


RESULTS
We performed 298 ERCP, 176 sphincterotomies and 20 TS (11.3% of sphincterotomies). Cannulation was achieved in 90% of the patients overall and immediate cannulation was achieved in 85%. The percentage of complications was 15% and none were severe. There were no cases of post-ERCP pancreatitis or mortality due to complications.


CONCLUSIONS
TS is an effective technique in gaining immediate access to the biliary tract in a high percentage of patients when access cannot be obtained using routine methods. The risk of complications in not higher than that of other pre-cut techniques.
Espinel-Díez
J
J
Servicio de Aparato Digestivo, Hospital de León, León, España. jespinel@telefonica.net
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D001662:Biliary Tract Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D015415:Biomarkers; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D009803:Sphincter of Oddi / Q000601:surgery*
D015415:Biomarkers; D000681:Amylases