title: Case series of transpancreatic septotomy as precutting technique for difficult bile duct cannulation.
abstract: OBJECTIVE
  Transpancreatic septotomy can be used instead of other precut techniques to facilitate bile duct cannulation after multiple failed attempts. Within the framework of a prospective randomized study on pentoxifylline, precut cases were retrospectively analyzed.
  
  
  METHODS
  Of 320 endoscopic retrograde cholangiopancreatographies (ERCPs) in 306 patients with various indications who had a naïve papilla, 34 cases of transpancreatic septotomy were identified and compared with 15 needle-knife sphincterotomies; six patients had received both techniques for bile duct access. Complications were defined according to consensus criteria.
  
  
  RESULTS
  In the 55 patients in whom precutting techniques were employed, the use of both techniques alone or in combination resulted in a final common bile duct cannulation rate of 81.8%. Five patients developed complications (9.1%). Of the two cases of pancreatitis (3.6%), one was mild and one severe (combined group). Of the three cases with hemorrhage, one was mild (transpancreatic septotomy) and two severe (needle knife). In patients who underwent conventional pull-type sphincterotomy (n = 242), 6.2% developed complications (nine pancreatitis and six hemorrhage).
  
  
  CONCLUSIONS
  In cases of difficult bile duct cannulation, transpancreatic septotomy seems to be a safe alternative to needle-knife precutting with reasonable success rates. It should be studied in prospective randomized trials.
authors: Gastroenterology Department, George Papanikolaou Hospital, Thessaloniki, Greece. dkapetan@otenet.gr
authors: D
authors: D
authors: Kapetanos
authors: G
authors: G
authors: Kokozidis
authors: D
authors: D
authors: Christodoulou
authors: K
authors: K
authors: Mistakidis
authors: K
authors: K
authors: Dimakopoulos
authors: E
authors: E
authors: Katodritou
authors: G
authors: G
authors: Kitis
authors: E V
authors: EV
authors: Tsianos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies