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Volume 8 Journal of Gastrointestinal & Digestive System Gastro Meet 2018
August 06-07, 2018
August 06-07, 2018 Abu Dhabi, UAE
Gastroenterology and Digestive
Disorders
16th International Conference on
In pursuit of complete ERCP: Contrast-assisted cannulation beyond wire guided cannulation
Noriyuki Nishino
Southern TOHOKU General Hospital, Japan
ERCP is the standard procedure for endoscopic biliary treatment. However the rate to access Bile Duct (BD) has not up to
100% on any facilities, between 92.5 with 98.7% in previous reports. How would we shoot the rest cases? Consider how to
improve them. Popular Wire-Guided Cannulation (WGC) would not elucidate unsuccessful cases owing all to endoscopist’s
skill without key images of cannulation difficulty. On the other hand Contrast-Assisted Cannulation (CAC) provides much
information. In practice, there are many anatomical variations of Intra-Ampullary Bifurcations (IAB). A small volume
of contrast may provide useful guidance for its variation and angle of IAB, furthermore the presence of Intra-Ampullary
Choledochocele (IAC), which has not reported. IAC is recognized a tiny cyst on midway of BD within ampulla by only CAC,
would require refractory pursuit the deformed axis even shown pathway. We report our consecutive data on our facility. We
have been consecutively performed ERCP with CAC for all patients. Our strategy was carried out with a small volume contrast
medium injection. A selective cannulation to BD was completed by a catheter operation only without Guide Wire (GW)
seeking. The success rate to access BD was 97.9% and overall post-ERCP pancreatitis was 1.6%. We consider the difficulty
of ERCP would be related with shape of papilla. We also show its variation and classification out of our accumulation. The
difficulty on ERCP was morphologically evaluated by anatomical IAB. IAC is only recognized by CAC even GW would not
trace the deformed axis. IAC would be one of the factors for difficult ERCP, therefore CAC would be a preferable strategy to
identify the presence of IAC. Careful treatment under knowledge of IAB would provide secure and certain ERCP.
Biography
Noriyuki Nishino has his expertise in evaluation and passion in diagnosis and treatment of Gastroenterology, especially pancreatico-biliary system with ERCP and
diagnosis by Abdominal xerography. He has completed his Graduation from Jichi Medical University in 1987. He is a Director of Gastroenterology Center, Southern
TOHOKU Hospital.
Noriyuki Nishino, J Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C3-070