Magulick John P, Campbell Earl V, Muniraj Thiruvengadam, Jamidar Priya, Aslanian Harry
Department of Medicine, Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.
VideoGIE. 2020 Nov 19;6(1):49-53. doi: 10.1016/j.vgie.2020.10.005. eCollection 2021 Jan.
Biliary cannulation, although critical to procedural success in ERCP, can be difficult and, if unsuccessful, can lead to longer hospital stays, repeat procedures, and increased costs. Expertise in adjunct techniques, including access fistulotomy, can increase success rates and potentially avoid these issues. The aim of this case series is to describe the technique of access fistulotomy and illustrate key points that are important for successful biliary access.
Three cases are reviewed in which access fistulotomy was used to achieve biliary access. The steps for the procedure are reviewed, and key technical tips and anatomic landmarks are illustrated in the video.
Successful biliary access is obtained using fistulotomy in 3 cases. In each case, the anatomic landmarks of the papilla and intraduodenal biliary segment are reviewed. The first case illustrates a large papilla in which initial incision followed by careful exposure reveals a clear "onion ring" structure corresponding to the bile duct. The second case requires stepwise incision, each guided by anatomic landmarks before the biliary adventitia is identified, leading to biliary cannulation. In the third case, the utility of fistulotomy in a duodenal diverticulum is illustrated. Recognition of the distorted anatomy allowed precise, careful incision leading to biliary access.
Access fistulotomy is an invaluable technique to aid in biliary access. Knowledge of key landmarks and careful evaluation of the incision are critical to successful biliary access when performing fistulotomy.
胆管插管虽然对内镜逆行胰胆管造影术（ERCP）的手术成功至关重要，但可能具有挑战性，若不成功，可能导致住院时间延长、重复手术及费用增加。包括瘘管切开术在内的辅助技术方面的专业知识可提高成功率，并有可能避免这些问题。本病例系列的目的是描述瘘管切开术的技术，并阐述对于成功胆管插管很重要的关键点。
回顾了3例使用瘘管切开术实现胆管插管的病例。回顾了该手术的步骤，并在视频中展示了关键技术要点和解剖标志。
3例均通过瘘管切开术成功实现胆管插管。在每例中，均对乳头和十二指肠内胆管段的解剖标志进行了回顾。第一例显示一个大乳头，最初切开并仔细暴露后可见对应胆管的清晰“洋葱环”结构。第二例需要逐步切开，每次均以解剖标志为引导，直至识别出胆管外膜，从而实现胆管插管。第三例展示了瘘管切开术在十二指肠憩室中的应用。认识到解剖结构的变形后进行精确、仔细的切开，从而实现胆管插管。
瘘管切开术是有助于胆管插管的一项宝贵技术。进行瘘管切开术时，了解关键标志并仔细评估切口对于成功胆管插管至关重要。
