title: Endoscopic transpancreatic septotomy as a precutting technique for difficult bile duct cannulation.
abstract: OBJECTIVE
  To evaluate the technique of transpancreatic septotomy (TS) for cannulating inaccessible common bile ducts in endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  Between May 2012 and April 2013, 1074 patients were referred to our department for ERCP. We excluded 15 patients with previous Billroth II gastrectomy, Roux-en-Y anastomosis, duodenal stenosis, or duodenal papilla tumor. Among 1059 patients who underwent ERCP, there were 163 patients with difficult bile duct cannulation. Pancreatic guidewire or pancreatic duct plastic stent assistance allowed for successful ERCP completion in 94 patients. We retrospectively analyzed clinical data from 69 failed patients (36 transpancreatic septotomies and 33 needle-knife sphincterotomies).
  
  
  RESULTS
  Of the 69 patients who underwent precut papillotomy, common bile duct cannulation was successfully achieved in 67. The success rates in the TS and needle knife sphincterotomy (NKS) groups were 97.2% (35/36) and 96.9% (32/33), respectively, which were not significantly different (P > 0.05). Complications occurred in 11 cases, including acute pancreatitis (n = 6), bleeding (n = 2), and cholangitis (n = 3). The total frequency of complications in the TS group was lower than that in the NKS group (8.3% vs 24.2%, P < 0.05).
  
  
  CONCLUSIONS
  Pancreatic guidewire or pancreatic duct plastic stent assistance improves the success rate of selective bile duct cannulation in ERCP. TS and NKS markedly improve the success rate of selective bile duct cannulation in ERCP. TS precut is safer as compared with NKS.
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Lin
authors: L
authors: Miao
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Quan-Peng
authors: QP
authors: Li
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Ming-Hui
authors: MH
authors: Zhu
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Xian-Xiu
authors: XX
authors: Ge
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Hong
authors: H
authors: Yu
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Fei
authors: F
authors: Wang
authors: Lin Miao, Quan-Peng Li, Xian-Xiu Ge, Hong Yu, Fei Wang, Guo-Zhong Ji, Institute of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China.
authors: Guo-Zhong
authors: GZ
authors: Ji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cholangiopancreatography; Complication; Endoscopic retrograde; Needle-knife precut; Transpancreatic septotomy