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Mayer P, Christmann PY, Venkatasamy A, Uhl G, Vuola S, Heroin L, Habersetzer F. Post-cholecystectomy biliary leakage mimicking a neoplastic lesion: contribution of cholangioscopy in diagnosis and endoscopic treatment. Endosc Int Open 2023; 11:E885-E887. [PMID: 37810902 PMCID: PMC10558258 DOI: 10.1055/a-2160-5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/04/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Pierre Mayer
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - Pierre-Yves Christmann
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - Aina Venkatasamy
- Department of Radiology, IHU Strasbourg, Strasbourg, France
- INSERM UMR_S 1113 IRFAC, Université de Strasbourg, Strasbourg, France
- Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Georges Uhl
- Gastroenterology and Hepatology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sebastian Vuola
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - Lucile Heroin
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - François Habersetzer
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
- Inserm U1110, Université de Strasbourg, Strasbourg, France
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Ben Abdallah K, Hamzaoui L, Mahmoudi M, Cherif I, Ben Mohamed A, Yakoubi M, Khsiba A, Medhioub M, Azouz M. Predictive factors of difficult biliary cannulation: An experience of a tunisian tertiary center. Heliyon 2022; 8:e12526. [PMID: 36619425 PMCID: PMC9812703 DOI: 10.1016/j.heliyon.2022.e12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/03/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Selective biliary cannulation is a prerequisite for a successful endoscopic retrograde cholangiopancreatography (ERCP). However, conventional biliary access can be difficult. The aims of our study were to determine the prevalence of difficult biliary cannulation (DBC) and its associated factors and to describe the efficiency and safety of used standard and advanced cannulation techniques. Methods We conducted a single-center retrospective study including all patients with naïve papilla who had an ERCP procedure in Gastroenterology department of Mohamed Taher Maamouri Hospital from June 2019 to December 2021. Efficiency was defined as successful selective deep biliary cannulation. DBC was defined based on the presence of one or more of the European Society of Gastrointestinal Endoscopy (ESGE) criteria (5-5-1): more than five cannulation attempts, more than 5 min before cannulation and more than one accidental passage in the wirsung. Prevalence was measured using ESGE 5-5-1 cutoffs and chinese set cutoffs 15-10-2. Predictors of DBC were sought by univariate and multivariate analysis (SPSS software, p significant if < 0.05). Results We included 664 patients (mean age 62 years and sex ratio M/W = 0.8). Main indication for ERCP was choledocholithiasis (67%, n = 442) followed by malignant biliary stenosis (21%, n = 138). Based on ESGE criteria, prevalence of DBC was 42.62% (n = 283). Prevalence was 21.15% when 15-10-2 cutoffs are applied in trainee-involved procedure. Cumulative biliary success rate was 96.46%. Standard cannulation method achieved access in 98.2% while advanced methods permitted success in 92.2% in fistulotomy, 94.1% in papillotomy and 77.3% in transpancreatic sphincterotomy. Independent predictive factors of DBC in multivariate analysis were: Trainee presence OR 1.80 [1.24-2.65], SOD OR 4.71 [1.11-19.88], biliary stenosis found on imaging examinations (OR 2.53 [1.63-3.92], small papilla OR 4.09 [1.82-9.17] and difficult orientation of the papilla OR 14.90 [3.28-67.62]. Conclusion DBC is a frequent endoscopic situation. Predictors of DBC can be related to trainee involvement in the procedure, anatomical and clinical factors. A thorough understanding of these factors can actively contribute to ERCP management plans.
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Affiliation(s)
- K. Ben Abdallah
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia,Corresponding author.
| | - L. Hamzaoui
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - M. Mahmoudi
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - I. Cherif
- Laboratory of Medical Epidemiology, Institut Pasteur de Tunis, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A. Ben Mohamed
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - M. Yakoubi
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - A. Khsiba
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - M. Medhioub
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - M.M. Azouz
- Gastroenterology Department, Mohamed Taher Maamouri University Hospital, Nabeul, Tunisia,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Is Cholecystectomy a cause of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography? Acta Gastroenterol Belg 2021; 84:563-569. [PMID: 34965037 DOI: 10.51821/84.4.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND STUDY AIM In European Society of Gastrointestinal Endoscopy guidelines, biliary cannulation of naive papillae is defined as difficult in the presence of more than 5 papilla contacts, more than 5min cannulation time or more than one unintended pancreatic duct cannulation or opacification. It is not known whether cholecystectomy is a cause of difficult biliary cannulation. This study aimed to investigate whether cholecystectomy (CCY) is a cause of difficult biliary cannulation in patients who have undergone Endoscopic Retrograde Cholangiopancreatography (ERCP) for choledocholithiasis. PATIENTS AND METHODS Adult patients with naive papillae and those who underwent ERCP for common bile duct stones and/or sludge were included in this retrospective study. Patient demographics, clinical presentation (acute cholangitis, biliary pancreatitis or biliary colic), periprocedural data including laboratory and radiological findings and ERCP results were compared between no-CCY and post-CCY groups. RESULTS 438 patients were included in the present study and 347 of these patients were in the no-CCY group and 91 patients were in post-CCY group. A statistically significant difference was found in the number of patients with difficult cannulation in the post-CCY group (n=30, 33.0%) patients compared to the no- CCY group (n=67, 19.3%) (p=0.011). According the multivariate analyses results, presence of history of cholecystectomy was found an independent risk factor of difficult cannulation (Odds ratio: 2.014; 95 % Cl 1.205-3.366; p=0.008). CONCLUSIONS The results showed that biliary cannulation was significantly more difficult in patients with cholecystectomy who underwent ERCP for common bile duct stones.
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