Abstract

GORI GIMENEZ, Hugo. Needle sphincterotomy. Gen [online]. 2013, vol.67, n.2, pp.116-121. ISSN 0016-3503.

The failed cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography is from 5 to 20% depending on operator expertise. The use of hydrophilic guides and the deep and selective cannulation are key to sucessfull access to the bile duct. Inadequate patient selection, small duodenal papilla or peridiverticular, impacted gallstone, Oddi dysfunction or repeated trauma during cannulation are the most common causes of failure. Needle-knife sphincterotomy in its two modalities: infundibulotomy and precut are optional techniques for accessing the bile duct when confronted with the conventional technique failure. Both techniques are equally effective for biliary choledocholithiasis. Hyperamylasemia is more common in the precut (17.75%) infundibulotomy (2.7% ). The incidence of post cholangiography pancreatitis is 15% after 15 or more cannulation attempts. Pancreatitis in precut can reach 8% and is rare during the infundibulotomy. Bleeding occurs in a similar way in both techniques. Early needle-knife use, in failed in cannulation decreases the occurrence of post procedure pancreatitis. It must be perfomed by experts in the technique that are able to manage eventual complications beside having adequate equipment and materials available.

Keywords : Commun bile duct; Failed Cannulation; Needle-knife sphincterotomy; precut sphincterotomy; Infundibulotomy.

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