Fogel E L, Sherman S, Lehman G A
Indiana University Medical Center, Indianapolis, USA.
Gastrointest Endosc. 1998 May;47(5):396-400. doi: 10.1016/s0016-5107(98)70226-3.
Selective biliary cannulation is often difficult when there is a periampullary diverticulum, especially when the papilla is within the diverticulum. We report eight such cases in which a new technique was used to achieve biliary access.
Among 4138 ERCPs, there were 246 cases (5.9%) with periampullary diverticula. Biliary cannulation initially failed in eight patients (3.3%), five of whom had previously undergone six failed attempts at other institutions. A technique was used whereby the papilla was kept out of the diverticulum by placement of a pancreatic duct stent. Needle-knife sphincterotomy was then performed followed by attempts to achieve biliary access.
Biliary entry was immediately successful in five patients and successful at a second ERCP in two (overall success 87.5%). Two patients developed post-ERCP pancreatitis.
When the papilla is within the periampullary diverticulum, placement of a main pancreatic duct stent keeps the papilla out of the diverticulum, thereby facilitating pre-cut needle-knife sphincterotomy and selective biliary cannulation.
当存在壶腹周围憩室时，尤其是乳头位于憩室内时，选择性胆管插管往往很困难。我们报告了8例采用新技术实现胆管通路的此类病例。
在4138例内镜逆行胰胆管造影（ERCP）中，有246例（5.9%）存在壶腹周围憩室。8例患者（3.3%）胆管插管最初失败，其中5例患者此前在其他机构曾有6次插管尝试失败。采用一种技术，通过放置胰管支架使乳头不位于憩室内。然后进行针刀括约肌切开术，随后尝试实现胆管通路。
5例患者胆管插管立即成功，2例在第二次ERCP时成功（总体成功率87.5%）。2例患者发生了ERCP术后胰腺炎。
当乳头位于壶腹周围憩室内时，放置主胰管支架可使乳头不位于憩室内，从而便于进行预切开针刀括约肌切开术和选择性胆管插管。
