Background and Aims

Balloon enteroscopy–assisted ERCP (BE-ERCP) is useful for treating pancreatobiliary disease in patients with surgically altered anatomy (SAA); however, biliary cannulation, including the precut technique, is often challenging. This study aimed to examine the feasibility of scissor-type knife precutting (SKP) during BE-ERCP in patients with SAA.

Methods

This retrospective study investigated consecutive patients who underwent BE-ERCP and SKP for difficult biliary cannulation between 2016 and 2021. The study outcomes included the technical success and adverse event rates associated with SKP during BE-ERCP.

Results

During the study period, 125 patients with native duodenal papillae underwent BE-ERCP, and the papilla was reached in 116 patients. The success rate of biliary cannulation with the standard cannulation approach alone was 67.2% (78/116), which increased to 77.6% (90/116) with the inclusion of advanced cannulation techniques besides precutting and further improved to 87.9% (102/116) with the addition of needlife precutting. SKP was attempted in 12 patients in whom all other cannulation approaches were difficult or resulted in failure. The technical success rate of SKP was 66.7% (8/12); thus, SKP increased the final success rate of biliary cannulation to 94.8% (110/116). The rate of adverse events associated with SKP was 8.3% (1/12).

Conclusions

This is the first study to report the use of the SKP technique for difficult biliary cannulation in patients with SAA, which may serve as a useful option for salvage cannulation during BE-ERCP.

中文翻译：

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球囊小肠镜辅助 ERCP 中的剪式刀预切用于胆管插管困难和手术改变解剖结构的患者（附视频）

背景和目标

球囊小肠镜辅助 ERCP (BE-ERCP) 可用于治疗手术改变解剖 (SAA) 患者的胰胆疾病；然而，胆管插管，包括预切技术，通常具有挑战性。本研究旨在探讨 SAA 患者 BE-ERCP 期间剪刀式预切刀 (SKP) 的可行性。

方法

这项回顾性研究调查了 2016 年至 2021 年间因胆管困难插管而接受 BE-ERCP 和 SKP 的连续患者。研究结果包括 BE-ERCP 期间与 SKP 相关的技术成功率和不良事件发生率。

结果

在研究期间，125 名具有天然十二指肠乳头的患者接受了 BE-ERCP，其中 116 名患者达到了乳头。仅使用标准插管方法的胆管插管成功率为 67.2% (78/116)，在预切之外采用先进的插管技术后，成功率提高到 77.6% (90/116)，进一步提高到 87.9% (102/116) ) 加上needlife precutting。对 12 名其他所有插管方法都困难或失败的患者进行了 SKP。SKP技术成功率为66.7%（8/12）；因此，SKP 将胆管插管的最终成功率提高到 94.8% (110/116)。与 SKP 相关的不良事件发生率为 8.3% (1/12)。

结论

这是第一项报告使用 SKP 技术治疗 SAA 患者困难的胆管插管的研究，这可能是 BE-ERCP 期间抢救插管的有用选择。