Title

When Standard Cannulation Approaches Fail

Keywords

Choledochoduodenostomy; Combined procedure; Double guide wire; EUS; Fistulotomy; Hepaticogastrostomy; Needle knife; Precut; PTC; Rendezvous

Abstract

Ductal cannulation is a prerequisite to successful biliary or pancreatic therapy during ERCP. Advanced techniques are required when standard methods of biliary cannulation fail, the papilla cannot be reached, or there is altered surgical anatomy. Initial options include the double guide wire technique, pancreatic stent and needle-knife sphincterotomy (NKS), or precut sphincterotomy. The latter includes a papillary "fistulotomy" technique. If these fail, combined or rendezvous procedures via the percutaneous transhepatic cholangiography (PTC) or under EUS guidance may be required. An EUS-guided choledochoduodenostomy or hepaticogastrostomy can be created if a rendezvous procedure is not technically possible. ERCP in patients with altered surgical anatomy is most challenging. A balloon-assisted enteroscope or a laparoscopic port can be used if the afferent limb is long.

Publication Date

12-19-2014

Publication Title

ERCP: The Fundamentals: Second Edition

Number of Pages

121-137

Document Type

Article; Book Chapter

Personal Identifier

scopus

DOI Link

https://doi.org/10.1002/9781118769409.ch8

Socpus ID

84976338979 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/84976338979

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