title: Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation.
abstract: OBJECTIVE
  Several precut techniques have been used to gain biliary access for difficult cases. The aim of this study was to evaluate the success and complication rates of two precut techniques, transpancreatic septotomy (TPS) and needle knife infundibulotomy (NKI), in difficult biliary cannulation due to the presence of unintended pancreatic cannulation.
  
  
  METHODS
  Eighty-six patients who failed standard biliary cannulation were included. TPS was performed when we failed to achieve biliary access despite 5 minutes of attempted cannulation or when more than three attempted unintended pancreatic cannulations occurred. If deep cannulation was not achieved within 5 minutes for any duct, NKI was performed. If this failed, we crossed over to the other technique in the second attempt.
  
  
  RESULTS
  The initial total success rate of biliary cannulation was 88.4% (86.6% for the TPS group and 94.7% for the NKI group, p=0.447). After crossover of the techniques, the final success rate was 95.3%. The complication rate was 20.9% in patients with TPS and 15.8% in patients with NKI (p=0.753).
  
  
  CONCLUSIONS
  The use of different strategies based on the presence of unintended pancreatic cannulation may help increase the success rate for difficult biliary cannulation without increasing complication rates.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yun Kyung
authors.initials: YK
authors.lastname: Park
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kyu Taek
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Kwang Hyuck
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Jong Kyun
authors.initials: JK
authors.lastname: Lee
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000601:surgery; D001660:Biliary Tract Diseases / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments; D016896:Treatment Outcome
keywords: Cholangiopancreatography, endoscopic retrograde; Difficult biliary cannulation; Needle knife infundibulotomy; Transpancreatic septotomy