Kim Joonhwan, Lee Jun Soo, Kim Eui Joo, Kim Yeon Suk, Cho Jae Hee
Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
Korean J Gastroenterol. 2018 Mar 25;71(3):168-172. doi: 10.4166/kjg.2018.71.3.168.
Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced therapeutic procedure to manage choledocholithiasis and pancreatobiliary malignancy. On occasion, ERCP failure is encountered due to difficulties in cannulation. We assessed the safety and feasibility of cap-assisted ERCP via analyzing cases in which cannulation was complicated by periampullary diverticulum. Between November 2013 and March 2014, ERCP procedures were performed in 346 patients in our tertiary medical center. Among the 73 patients who had a periampullary diverticulum, conventional ERCP failed in 5 patients due to hidden papilla (n=3) or use of tangential approach (n=2). As a rescue method, needle knife fistulotomy and selective biliary cannulation using cap-fitted forward-viewing endoscopy were successfully used in 4 patients without major complications. Based on our experience, cap-fitted forward-viewing endoscopy was relatively easy to measure the exact position of papilla and to perform biliary cannulation properly. Therefore, we recommend using cap-assisted ERCP by forward-viewing endoscopy as a useful and safe alternative to manage patients in whom cannulation is complicated by periampullary diverticulum.
内镜逆行胰胆管造影术（ERCP）是一种用于治疗胆总管结石和胰胆恶性肿瘤的先进治疗方法。有时，由于插管困难会导致ERCP失败。我们通过分析因壶腹周围憩室导致插管困难的病例，评估了帽辅助ERCP的安全性和可行性。2013年11月至2014年3月，我们三级医疗中心对346例患者进行了ERCP手术。在73例有壶腹周围憩室的患者中，5例因乳头隐匿（n = 3）或采用切线进镜法（n = 2）导致传统ERCP失败。作为一种补救方法，4例患者成功采用针刀瘘管切开术和使用带帽前视内镜进行选择性胆管插管，无重大并发症。根据我们的经验，带帽前视内镜相对容易准确测量乳头位置并正确进行胆管插管。因此，我们建议使用带帽前视内镜辅助ERCP作为一种有用且安全的替代方法，用于处理因壶腹周围憩室导致插管困难的患者。
