Enlarged fistulotomy of the papilla as access to the biliary tract during ERCP

BACKGROUND

Demonstration of access to the bile duct through Enlarged Papillary Fistulotomy, a method different from conventional fistulotomy.

AIMS

Demonstration of the EFP technique with dissection in layers of the papilla for accessing the common bile duct, its efficiency and safety, rescue of cases of failure in cannulation and cases of access failure by EFP in the first attempt, facilitating cannulation in the second attempt.

METHODS

Cross-sectional study, with retrospective data collection from 2233 ERCP exams with 528 EFP procedures, analysis of success and complications.

RESULTS

528 patients underwent EFP on the first attempt, with success in 465 cases (88.06%) and 63 failures (11.94%). Of these failures, 33 patients (52.38%) returned for a second EFP attempt, with success in 30 cases (90.9%) and failure in 3 cases (9.1%). Deep bile duct cannulation was achieved in 93.75% of EFP procedures, and cannulation failure occurred in 33 cases (6.25%).

CONCLUSION

EFP showed efficiency in CBD cannulation, did not induce post-ERCP pancreatitis, no cases of perforation or false tract, but resulted in higher rates of minor bleeding, rescued cases of access failure by EFP, facilitated the posterior approach on the second attempt, it is safe, effective, low risk and associated with few comorbidities.

[Endoscopic and histopathologic changes in the gastric mucosa in Billroth II gastrectomy and in Roux-en-Y]

The gastric mucosa changes induced by enterogastric reflux remain to interest, thus, 20 patients with surgical duodenal ulcer disease were studied, and after raffle, they consisted in 2 groups of 10 patients each, in which were performed antrectomy and truncal vagotomy, with reestablishment of the gastrointestinal continuity, in the group I, through a Billroth II gastrojejunostomy, and, in the group II, by a Roux-en-Y gastrojejunostomy. In the preoperative course, all the patients were undergone to endoscopic and histopathologic studies, when body gastric mucosa biopsies were analysed; after an average time of follow-up about 7.3 months for the group I, and 8.9 months for the group II, these studies were repeated in an attempt to check, in these 2 groups, the presence of gastric mucosa changes on the gastric remnant induced by reflux of alkaline juices. According to Fisher's exact test the outcome of these searches were significants when had compared the bile reflux into the stomach (p = 0.0549), gastritis (p = 0.00) and anastomosis changes (p = 0.0899) at endoscopic study, and were not significants when it comes to the condition of chronic gastritis (p = 0.6672) present at histopathologic study.