Intramural incision technique: a useful and safe procedure for obtaining ductal access during ERCP

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doi:10.1016/j.gie.2007.03.1077 Copyright © 2008 American Society for Gastrointestinal Endoscopy Published by Mosby, Inc.

Original article

Intramural incision technique: a useful and safe procedure for obtaining ductal access during ERCP

Sri Prakash Misra MD, DM, FRCP, FACG, a and Manisha Dwivedi MD, DM, FACGa aCurrent affiliations: Department of Gastroenterology, Moti Lal Nehru Medical College, University of Allahabad, Allahabad, India Received 21 January 2007; accepted 26 March 2007. Allahabad, India. Available online 12 September 2007.

Background

Intramucosal incision technique is a useful procedure to achieve ductal access in patients undergoing ERCP. However, the procedure has been underused. Objective

Our purpose was to evaluate the efficacy and safety of the intramucosal incision technique and to compare it with standard precut needle-knife papillotomy. Setting

A large teaching hospital. Patients

Patients undergoing endoscopic sphincterotomy. Interventions

If a complete or an incomplete false tract formed during probing for the biliary ductal system, the intramucosal incision technique was attempted. Needle-knife precut papillotomy was performed in those in whom bile duct access could not be obtained even after 4 attempts at cannulating the bile duct. Main Outcome Measurements

The success rate and complications of the intramucosal incision technique were compared with those for kneedle-knife papillotomy. Results

The intramucosal incision technique was attempted in 23 patients and was successful in 22. A definitive procedure could be performed in all 22 patients, and mild pancreatitis developed in only one of them (4.5%). During the same period, needle-knife papillotomy was attempted in 169 patients. Biliary access was gained in 159 (94%) patients. Complications occurred in 14 (8.2%) patients (mild pancreatitis in 6, moderate pancreatitis in 2, bleeding requiring endoscopic therapy in 5, and perforation in 1 patient). Limitations

Single center study. Conclusions

Intramucosal incision technique is a very useful and safe procedure and should be performed if a false tract has formed during probing for ductal access during ERCP.

Reprint requests: Sri P. Misra, MD, Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad 211 001, India.

Gastrointestinal Endoscopy Volume 67, Issue 4, April 2008, Pages 629-633