Neelam Pardhu Bharat, Mandavdhare Harshal S
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
Indian J Gastroenterol. 2025 Feb 7. doi: 10.1007/s12664-024-01718-8.
Selective biliary cannulation is the prerequisite for successful biliary interventions. In the setting of cannulation failure, various rescue cannulation techniques are used for achieving selective biliary access. The various rescue cannulation techniques are (1) free-hand techniques (precut papillotomy and fistulotomy); (2) wire-guided techniques (transpancreatic sphincterotomy [TPS] and double guidewire [DGW]) and (3) endoscopic ultrasound (EUS)-guided technique (EUS-guided rendezvous for biliary access). The morphology of the papilla is the best guide to select the rescue technique. For classic and pendulous down facing papilla, pre-cut fistulotomy is preferable while for irregular ridged type, pre-cut papillotomy is suitable, while for small flat type, a very cautious pre-cut papillotomy may be utilized only by experts in pre-cut techniques. When an inadvertent pancreatic duct cannulation occurs, TPS is the preferred technique for all except small flat type of papilla where DGW is preferable to avoid perforation. We review the literature comparing these techniques to assess their efficacy and safety. Finally, we provide an algorithm that can be used to select the best rescue technique.
选择性胆管插管是成功进行胆管介入治疗的前提条件。在插管失败的情况下，可采用各种补救插管技术来实现选择性胆管通路。这些补救插管技术包括：（1）徒手技术（预切开乳头括约肌切开术和瘘管切开术）；（2）导丝引导技术（经胰管括约肌切开术[TPS]和双导丝[DGW]）；以及（3）内镜超声（EUS）引导技术（EUS引导下胆管会师术）。乳头的形态是选择补救技术的最佳指南。对于典型的、下垂型乳头，预切开瘘管切开术更为可取；对于不规则嵴状乳头，预切开乳头括约肌切开术合适；而对于小扁平型乳头，只有预切开技术专家才可非常谨慎地使用预切开乳头括约肌切开术。当意外发生胰管插管时，除小扁平型乳头（此时DGW更可取以避免穿孔）外，TPS是所有情况下的首选技术。我们回顾了比较这些技术的文献，以评估它们的疗效和安全性。最后，我们提供了一种可用于选择最佳补救技术的算法。
