Feasibility of the mucosa-tracking technique in precut papillotomy with the iso-tome as an alternative to the needle-knife technique.
OBJECTIVE
The aim of this study was to evaluate whether the mucosa-tracking technique is effective for improving precutting-related pancreatitis and the sustained failure of bile duct cannulation in precut papillotomy (PP) with the Iso-Tome (MTW Endoskopie).


METHODS
From September 2004 to June 2006, PP was performed with the Iso-Tome if biliary cannulation failed by conventional methods for approximately 5 minutes. The pink intrapapillary mucosa (PIPM) exposed by PP was tracked and classified into four groups: fully exposed and oriented to the direction of the bile duct (group A) or the pancreatic duct (group B), partially exposed (group C), or unexposed (group D). The success rate of bile duct cannulation (SRBC), the procedure time required for successful bile duct cannulation (PTBC), and the complications in the first session were compared between the mucosa-exposed groups (MEGs; group A, B, and C) and the mucosa-unexposed group (MUEG; group D).


RESULTS
A total of 59 patients (25 females, 34 males) with a mean age of 65.2 years were enrolled. The MEGs and MUEG comprised 52 (88.1%) and 7 (11.9%) patients, respectively. SRBC in the first session was 86.4% (51/59) in total and 92.3% (48/52) in the MEGs, compared to only 42.9% (3/7) in the MUEG (p=0.005). The mean PTBC in the MEGs and MUEG was 8.7 minutes and 16.3 minutes, respectively (p=0.23). Complications occurred in 6.8% of the patients (4/59; all pancreatitis); there were no differences between the MEGs (5.8%, 3/52) and MUEG (14.3%, 1/7; p=0.41). All four patients with pancreatitis were managed medically.


CONCLUSIONS
The mucosa-tracking technique in PP with the Iso-Tome is a feasible and useful method of enhancing SRBC. PIPM is an important endoscopic landmark for successful PP.
Park
Sang-Heum
SH
Division of Gastroenterology/Hepatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Park
Do Hyun
DH
Lee
Tae Hoon
TH
Lee
Ho-Sung
HS
Lee
Yong-Sub
YS
Lee
Sae Hwan
SH
Lee
Chang Kyun
CK
Lee
Suck-Ho
SH
Chung
Il-Kwun
IK
Kim
Hong Soo
HS
Lee
Hyo-Jin
HJ
Kim
Sun-Joo
SJ