[ERCP: ampulotomy or suprapapillary fistulotomy with needle knife to access bile duct in difficult cannulation].

INTRODUCTION

Biliary conducts deep cannulation is a requirement for therapeutic Endoscopic Retrograde Cholangio-Pancreatography (ERCP). The pre-cut papillotomy is a technique for difficult cannulation cases.

AIMS

Report cases of hard cannulation and suprapapilar fistulotomy as a method for selective common bile duct cannulation. Report efficacy, demographic and endoscopic findings and complications of this procedure.

MATERIALS AND METHODS

Observational, descriptive and prospective study of cases. Sample of 93 patients who had a difficult cannulation ERCP, in which suprapapilar fistulotomy pre-cut type was done, in a private digestive endoscopic center between 2000 and 2010 in Lima, Peru.

RESULTS

1205 (100%) ERCP were made 1152 (96%) papillosphincterotomies. Fistulotomy was done in 93 cases (8%) of these papillosphincterotomies. The most prevalent age group was 61 to 70 years old, the female-male proportion was 2.4:1. The efficacy was 96%. The most prevalent endoscopy findings were odditis, gallstone impactation and ampulloma presence, final diagnosis were lithiasic disease (34%), Odditis with or without common bile duct lithiasis (29%). Therapeutic ERCP was done in 75% of the cases, 8.5% showed complications (pancreatitis and bleeding). No perforation or cholangitis were registered.

CONCLUSIONS

In this case series, fistulotomy in difficult cannulation procedures had good efficacy. Is most prevalent in cases with odditis, gallstone impactation and ampulloma. Complications of the procedure are low.

RECOMMENDATIONS

The fistulotomy type of pre-cut is leaded for patients who require therapeutic ERCP. The decision for doing the procedure must be precocious and informed consent is primordial.