Mishra Ankit, Meade Charles, Schulman Allison R, Philips George, Machicado Jorge D
Department of Internal Medicine, University of Michigan, Ann Arbor, United States.
Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, United States.
Endosc Int Open. 2025 Jan 29;13:a25097369. doi: 10.1055/a-2509-7369. eCollection 2025.
There are few salvage techniques for achieving biliary cannulation when no duct can be accessed.
We retrospectively reviewed 10 consecutive cases in which the mini-forceps traction-assisted cannulation technique (MFTAC) was used after failure of any duct access during endoscopic retrograde cholangiopancreatography (ERCP). Outcomes included technical success, use of adjunct techniques; time to biliary access; and adverse events (AEs).
Most patients had a native papilla (n = 9) of peri-diverticular location (n = 5) and a benign indication (n = 6). Standard cannulation was unsuccessful over 8:23 mm:ss (interquartile range [IQR] 6:04-19:43). MFTAC had 100% technical success, achieved biliary access after 17:38 mm:ss (IQR 8:52-20:31), and had a 10% incidence of AEs (post-ERCP pancreatitis). MFTAC was sufficient to allow biliary cannulation in three cases and allowed pancreatic duct access in seven cases, which then allowed biliary cannulation with double-wire technique (5/10) and transpancreatic septotomy (2/10).
MFTAC is a feasible salvage approach for biliary access when standard cannulation methods fail.
当无法找到胆管进行插管时，可采用的挽救技术很少。
我们回顾性分析了连续10例患者，这些患者在内镜逆行胰胆管造影术（ERCP）中无法找到任何胆管进行插管后，采用了微型钳牵引辅助插管技术（MFTAC）。结果包括技术成功率、辅助技术的使用、胆管插管时间以及不良事件（AE）。
大多数患者有先天性乳头（n = 9），位于憩室周围（n = 5），且为良性病变（n = 6）。标准插管在8分23秒（四分位间距[IQR] 6分04秒 - 19分43秒）内未成功。MFTAC技术成功率为100%，在17分38秒（IQR 8分52秒 - 20分31秒）后成功进行胆管插管，不良事件发生率为10%（ERCP术后胰腺炎）。MFTAC足以使3例患者成功进行胆管插管，7例患者成功进入胰管，随后通过双线技术（5/10）和经胰隔切开术（2/10）实现胆管插管。
当标准插管方法失败时，MFTAC是一种可行的胆管插管挽救方法。
