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- Title
Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography.
- Authors
Yasuhiro Kuraishi; Kazuo Hara; Shin Haba; Takamichi Kuwahara; Nozomi Okuno; Takafumi Yanaidani; Sho Ishikawa; Tsukasa Yasuda; Masanori Yamada; Nobumasa Mizuno
- Abstract
Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3-20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3-15 minutes). Conclusions: Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.
- Subjects
ENDOSCOPIC retrograde cholangiopancreatography; CONSERVATIVE treatment; CATHETERIZATION
- Publication
Clinical Endoscopy, 2023, Vol 56, Issue 4, p490
- ISSN
2234-2400
- Publication type
Article
- DOI
10.5946/ce.2022.130