title: Additional biliary cannulation methods in patients with juxtapapillary duodenal diverticula.
abstract: OBJECTIVE
  Juxtapapillary diverticula (JPD) can increase the difficulty of biliary cannulation. A number of additional methods have been defined in case of failed cannulation attempt by standard technique. We aimed to investigate the more commonly preferred and practical additional methods among them.
  
  
  METHODS
  A total of 1,205 endoscopic retrograde cholangiopancreatographies (ERCP) performed during a study period of 14 months were prospectively entered into a database. Of these, 222 (18 %) had JPD (123 women, 99 men, mean age 69 years) and 983 had no diverticula (523 women, 460 men, mean age 57 years). Additional cannulation methods used in patients with JPD were recorded. Biliary cannulation time, total procedure time, use of pre-cut papillotomy, and therapeutic success of ERCP were compared between the groups as well.
  
  
  RESULTS
  Biliary cannulation was performed by standard technique in 210 patients with JPD (94.5 %). Cannulation was achieved by placement of a guidewire into the pancreatic duct in 6 (2.7 %) and use of two devices in one channel in 2 (0.9 %) patients. There was no significant difference between the total procedure time and therapeutic success of ERCP between the groups. Cannulation time was significantly longer in patients with JPD. Pre-cut papillotomy was performed less in patients with JPD.
  
  
  CONCLUSIONS
  Presence of JPD does not decrease the therapeutic success of ERCP. Placement of a guidewire in the pancreatic duct or use of two-devices-in-one-channel are practical, successful, safe, and preferred methods which can be used in patients with failed cannulation by standard technique.
authors.affiliation: Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey. drerkanparlak@gmail.com
authors.forename: Erkan
authors.initials: E
authors.lastname: Parlak
authors.forename: Aydın Seref
authors.initials: AS
authors.lastname: Köksal
authors.forename: Selçuk
authors.initials: S
authors.lastname: Dişibeyaz
authors.forename: Bahattin
authors.initials: B
authors.lastname: Ciçek
authors.forename: Serkan
authors.initials: S
authors.lastname: Uysal
authors.forename: Nurgül
authors.initials: N
authors.lastname: Saşmaz
authors.forename: Burhan
authors.initials: B
authors.lastname: Sahin
mesh_terms: D000368:Aged; D000465:Algorithms; D001660:Biliary Tract Diseases / Q000473:pathology* / Q000628:therapy*; D002404:Catheterization / Q000379:methods*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004240:Diverticulum / Q000473:pathology*; D004378:Duodenal Diseases / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome