Tip palpation of the intraduodenal biliary segment for needle-knife fistulotomy

Q3 Medicine

VideoGIE Pub Date : 2025-03-25 DOI:10.1016/j.vgie.2025.03.031

Allison Franz MD , David Liu MD , Cristina Chiodi MD , Garvit Chabra MD , Peter V. Draganov MD , Nanlong Liu MD

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引用次数: 0

Abstract

Background and Aims

Needle-knife access fistulotomy (NKF) involves using a needle-knife to cut into the intraduodenal segment of the bile duct, thereby avoiding the papilla. Previous studies suggest this procedure decreases the risk of post-ERCP pancreatitis and increases successful biliary cannulation compared with conventional methods. In this case series, we introduce an advanced endoscopic technique aimed at aiding endoscopists with successful NKF and broadening use of this procedure.

Methods

Here we describe a technique in which we use the sphincterotome and needle-knife to palpate the intraduodenal biliary segment before needle-knife instrumentation. Careful dissection is then performed along this axis before achieving biliary cannulation with the sphincterotome and guidewire.

Results

All videos shown led to successful biliary cannulation with next-day discharges from the hospital and clinical success with biliary decompression.

Conclusions

Previous palpation for the bile duct may aid endoscopists with NKF. This may lead to wider adoption of NKF. Further prospective research is needed.

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针刀造瘘术中十二指肠内胆管段尖端触诊

背景和目的针刀入路瘘管切开术（NKF）是使用针刀切入胆管的十二指肠内段，从而避开乳头。先前的研究表明，与传统方法相比，该程序降低了ercp后胰腺炎的风险，并增加了成功的胆道插管。在本病例系列中，我们介绍了一种先进的内窥镜技术，旨在帮助内窥镜医师成功完成NKF并扩大该手术的使用范围。方法在此，我们描述了一种技术，我们使用括约肌切开术和针刀在针刀置入前触诊十二指肠内胆道段。然后沿着这条轴进行仔细的解剖，然后用括约肌切开术和导丝进行胆道插管。结果所有视频均显示胆道插管成功，次日出院，胆道减压临床成功。结论术前胆管触诊有助于内镜诊断胆管病变。这可能导致更广泛地采用NKF。需要进一步的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.