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Standard Cannulation versus Fistulotomy for Biliary Access in Endoscopic Retrograde Cholangiopancreatography

2024-02-14Artigo científico Acesso aberto
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dc.contributor.authorMoreira, Marta
dc.contributor.authorTarrio, Isabel
dc.contributor.authorAndrade, Alda João
dc.contributor.authorAraújo, Tarcísio
dc.contributor.authorFernandes, João Sousa Silva
dc.contributor.authorCanena, Jorge
dc.contributor.authorCanena, Jorge
dc.contributor.authorLopes, Luís
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblKarger
dc.date.accessioned2024-03-06T23:52:56Z
dc.date.available2024-03-06T23:52:56Z
dc.date.issued2024-02-14
dc.descriptionPublisher Copyright: © 2024 S. Karger AG. All rights reserved.
dc.description.abstractIntroduction: To access the common bile duct in endoscopic retrograde cholangiopancreatography (ERCP), needle-knife fistulotomy (NKF) can be associated with a shorter sphincterotomy compared to standard cannulation. We aimed to compare the success and safety of NKF versus standard cannulation in the treatment of choledocholithiasis. Methods: A cohort of 379 naïve patients with choledocholithiasis who underwent ERCP between 2005 and 2022 was retrospectively analyzed. The patients were divided into two groups: group A (179 consecutive patients) underwent NKF, while group B (180 patients) received standard biliary access and were matched for stone characteristics and ERCP year. Results: Stone removal success rate for group A was significantly lower than that for group B in the initial ERCP (82.0% vs. 92.1%, p = 0.003). In group A, success rates for stone removal were 90.2%, 80%, and 29.4% for stone sizes <10 mm, 10 mm-15 mm, and >15 mm, respectively (p < 0.001). In contrast, group B showed success rates of 99.2%, 81.5%, and 71.4% for the same stone size categories (p < 0.001). Pancreatitis occurred in 3.7% of group A and 5.8% of group B patients (p = 0.340). Regression analysis revealed that NKF cannulation, stone size (>10 mm), and having 4 or more stones were associated with lower stone removal success compared to standard cannulation in the initial ERCP (OR 0.34, p = 0.015; stone size 10-15 mm: OR 0.20, p < 0.001; stone size >15 mm: OR 0.05, p < 0.001; 4 or more stones: OR 0.4, p = 0.040). Conclusions: The removal of common bile duct stones after NKF access, although safe and effective, is less successful than after a standard cannulation, especially at the baseline ERCP.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent284384
dc.identifier.doi10.1159/000536398
dc.identifier.issn2341-4545
dc.identifier.otherPURE: 84546852
dc.identifier.otherPURE UUID: 1ce8360c-0b6f-4030-abe3-76038033d66b
dc.identifier.otherScopus: 85185816339
dc.identifier.otherPubMed: 39633909
dc.identifier.urihttp://hdl.handle.net/10362/164574
dc.identifier.urlhttps://www.scopus.com/pages/publications/85185816339
dc.language.isoeng
dc.peerreviewedyes
dc.subjectCatheterization
dc.subjectCholedocholithiasis
dc.subjectEndoscopic retrograde cholangiopancreatography
dc.subjectNeedle-knife fistulotomy
dc.subjectPrecut techniques
dc.subjectGastroenterology
dc.titleStandard Cannulation versus Fistulotomy for Biliary Access in Endoscopic Retrograde Cholangiopancreatographyen
dc.title.subtitleShould We Expect the Same Success when Treating Choledocholithiasis?en
dc.typejournal article
degois.publication.firstPage401
degois.publication.issue6
degois.publication.lastPage407
degois.publication.titleGE Portuguese Journal of Gastroenterology
degois.publication.volume31
dspace.entity.typePublication
person.familyNameCanena
person.givenNameJorge
person.identifier.orcid0000-0002-2539-5876
person.identifier.ridI-1379-2015
person.identifier.scopus-author-id6507619160
rcaap.rightsopenAccess
relation.isAuthorOfPublicationc8b48309-6089-430b-834c-46b5f79108bc
relation.isAuthorOfPublication.latestForDiscoveryc8b48309-6089-430b-834c-46b5f79108bc

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