Korean Journal of Gastrointestinal Endoscopy 2000;20(4): 267-273.
내시경적 담도삽관을 위한 침형절개도를 이용한 누두절개술 ( Infundibulotomy ) 의 유용성 ( Efficacy of Needle-knife Infundibulotomy in Failed Cannulation on Endoscopic Retrograde Cholangiopancreatography )
김은주(Eun Joo Kim),정일권(Il Kwun Chung),김홍수(Hong Su Kim),이문호(Moon Ho Lee),김선주(Sun Joo Kim),박상흠(Sang Heum Park),오영수(Young Soo Oh)
Abstract
Background/Aims : Cannulation failure to biliary tract has been reported in 10% of patients who are performed diagnostic and therapeutic ERCP. Infundibulotomy by use of needle knife is cutting a bulbar part of protruding papilla, which has merit to avoid complete destruction of sphincter of Oddi and serious side effects than general precutting method. We want to know effectiveness and safety of infundibulotomy. Method : From January 1997 to December 1998, 36 patients who failed cannulation over three times trial by conventional method are included to this study. We compared the success rate of cannulation and procedure related complication according to bile duct dilatation, periampullary diverticulum and shape of ampulla of Vater. Results : 1) Success rate of cannulation to bile duct is 81% (29/36). 2) All patients in group of bile duct dilatation (14) are succeed to cannulation, which is significantly high compare to other group (p=0.0288). 3) There was no statistical difference in success rate according to presence of periampullary diverticulum. 4) In groups of bulging prominent papilla are succeed in 23 among 26 patients, which is tendency of high in patients than other group (p=0.0760). 5) Total occurrence of procedure related complication was 33% (12/36). 6) The complication rate was not different in two groups according to cannulation success 7) The complication rate was tendency of high in patients without bile duct dilatation (p=0.0756). Conclusions : Infundibulotomy by use of needle knife is effeetive and safe cannulation method to patient who failed cannulation to bile duct. Success of cannulation is low and occurrence of complication is tendency of high in patient without bile duct dilation, which propose endoscopists attention in selection of indications. (Korean J Gastrointest Endosc 2000;20:267-273)