and various procedure related factors including difficult cannulation, precut sphincterotomy
, pancreatic duct contrast injection, balloon sphincteroplasty and many more4.
Common risk factors included a clinical diagnosis of sphincter of Oddi dysfunction, precut sphincterotomy
, and endoscopic papillary balloon dilation which could predispose to Stapfer's Type II perforations.
Early precut sphincterotomy
and the risk of endoscopic retrograde cholangiopancreatography related complications: An updated meta-analysis.
Transpancreatic precut sphincterotomy (TPS) can be an alternative technique because the access is already in the MPD.
Precut technique can have needle knife precut (free hand cutting at the papillary orifice or cutting the papilla over a pancreatic stent), needle knife fistulotomy above papillary orifice, and transpancreatic precut sphincterotomy (TPS) using traction papillotome .
In cases of difficulty in cannulation, precut sphincterotomy
In a local study conducted by Haqqi on 50 patients regarding post ERCP pancreatitis, female gender (64%), precut sphincterotomy (68%), pancreatic duct contrast injections (54%), higher number of attempts of CBD cannulation and difficult CBD cannulation were recognized as factors for post ERCP pancreatitis10.
Our findings are in agreement with a local study conducted by Haqqi on 50 patients regarding post ERCP pancreatitis, female gender (64%), precut sphincterotomy (68%), pancreatic duct contrast injections (54%), higher number of attempts of CBD cannulation and difficult CBD cannulation were recognized as factors for post ERCP pancreatitis10.
We also collected information regarding the size and number of CBD stones, diameter of the CBD, presence of periampullary diverticulum or gastrectomy with Billroth II reconstruction, if EST was performed at the same time or previously and if precut sphincterotomy was required, maximum diameter of dilatation, need to use ML for stone removal, and degree of difficulty of ERCP according to the ASGE classification .
It was necessary to perform a precut sphincterotomy in 9 cases (4.5%) and ML in 13 cases (6.5%) to successfully complete the procedure.
Some patients had different interventions during one procedure which included biliary sphincterotomy in 19 (36%) patients, pancreatic sphincterotomy in 14 (26.4%), pancreatic stenting in 9 (16.9%), CBD stent exchange in 6 (11.3%), precut sphincterotomy
in 5 (9.4%), cystogastrostomy in 4 (7.5%), pancreatic stent removal in 3 (5%), CBD stent insertion in 3 (5.6%), balloon sphincteroplasty in 2 (3.7%), and minor papilla sphincterotomy in 1 (1.8%) patient.
Needle knife precut sphincterotomy
(NKP) is performed as an alternative method when cannulation of the bile duct by conventional methods is difficult [3, 4].