Transnasal endoscopic retrograde chalangiopancreatography using an ultrathin endoscope: a prospective comparison with a routine oral procedure.
OBJECTIVE
To investigate if transnasal endoscopic retrograde cholangiopancreatography (n-ERCP) using an ultrathin forward-viewing scope may overcome the disadvantages of conventional oral ERCP (o-ERCP) related to the large-caliber side-viewing duodenoscope.


METHODS
The study involved 50 patients in whom 25 cases each were assigned to the o-ERCP and n-ERCP groups. We compared the requirements of esophagogastroduodenoscopy (EGD) prior to ERCP, rates and times required for successful cannulation into the pancreatobiliary ducts, incidence of post-procedure hyperamylasemia, cardiovascular parameters during the procedure, the dose of a sedative drug, and successful rates of endoscopic naso-biliary drainage (ENBD).


RESULTS
Screening gastrointestinal observations were easily performed by the forward-viewing scope and thus no prior EGD was required in the n-ERCP group. There was no significant difference in the rates or times for cannulation, or incidence of hyperamylasemia between the groups. However, the cannulation was relatively difficult in n-ERCP when the scope appeared U-shape under fluoroscopy. Increments of blood pressure and the amount of a sedative drug were significantly lower in the n-ERCP group. ENBD was successfully performed succeeding to the n-ERCP in which mouth-to-nose transfer of the drainage tube was not required.


CONCLUSIONS
n-ERCP is likely a well-tolerable method with less cardiovascular stress and no need of prior EGD or mouth-to-nose transfer of the ENBD tube. However, a deliberate application is needed since its performance is difficult in some cases and is not feasible for some endoscopic treatments such as stenting.
Mori
Akihiro
A
Department of Gastroenterology, Inuyama Chuo Hospital, Aichi 484-8511, Japan. a-mori@inuyamachuohospital.or.jp
Ohashi
Noritsugu
N
Maruyama
Takako
T
Tatebe
Hideharu
H
Sakai
Katsuhisa
K
Shibuya
Takashi
T
Inoue
Hiroshi
H
Takegoshi
Shoudou
S
Okuno
Masataka
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation* / Q000379:methods*; D004066:Digestive System Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D020776:Endoscopes, Gastrointestinal / Q000009:adverse effects; D005260:Female; D006801:Humans; D034321:Hyperamylasemia / Q000209:etiology; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D006993:Hypnotics and Sedatives