Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography

  • Yasuhiro Kuraishi (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Kazuo Hara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Shin Haba (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Takamichi Kuwahara (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nozomi Okuno (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Takafumi Yanaidani (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Sho Ishikawa (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Tsukasa Yasuda (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Masanori Yamada (Department of Gastroenterology, Aichi Cancer Center Hospital) ;
  • Nobumasa Mizuno (Department of Gastroenterology, Aichi Cancer Center Hospital)
  • Received : 2022.04.15
  • Accepted : 2022.06.30
  • Published : 2023.07.30
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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.

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References

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