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Titel: Gastrointestinal: No touch-guidewire cannulation in periampullary diverticulum
VerfasserIn: Zimmer, V.
Sprache: Englisch
Titel: Journal of Gastroenterology and Hepatology
Bandnummer: 35
Heft: 8
Seiten: 1261-1261
Verlag/Plattform: Wiley
Erscheinungsjahr: 2019
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: A 63-year-old female patient presented with biliary-type pain and laboratory cholestasis (γ-glutamyl transpeptidase 1.360 U/L, bilirubin 1.3 mg/dL). Transabdominal ultrasound indicated common bile duct (CBD) dilation with multiple stones. Due to lack of cholangitis, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) only the following day. Duodenoscopy indicated a wide-necked, type 1 periampullary diverticulum (PAD) with the ampulla at an unfavorable 8 o'clock position (Fig. 1a). Even after optimal adjustment of the duodenoscope position, the bile duct and papillotome axes could not be brought into proper alignment (Fig. 1b). Therefore, we applied a “no-touch” technique first cautiously engaging the papillary orifice with a straight-tipped hydrophilic guidewire (0.035-inch Jagwire, Boston Scientific, Natick, MA, USA) (Fig. 1c). After successful deep wire-guided cannulation, the papillotome was tracked into the CBD without difficulties (Fig. 1d, Video S1). Exuberant bile duct stone disease was confirmed and treated by endoscopic papillotomy and multiple basket extractions. PAD might add different levels of complexity to biliary cannulation, and myriad rescue techniques have been described to this end, highlighting the need for an individualized approach tailored to the distinct anatomy. The “no-touch” technique yielded no universal benefit in terms of cannulation success over a more conventional “touch” approach in a recent randomized trial (TNT trial). However, primary guidewire cannulation, considered more indulgent to deviations in cannulation axis often encountered in PAD-related anatomy, might be tried in the first-line prior to embarking on more complex bailouts with the often associated need to switch accessory and/or scope technology.
DOI der Erstveröffentlichung: 10.1111/jgh.14932
URL der Erstveröffentlichung: https://onlinelibrary.wiley.com/doi/full/10.1111/jgh.14932
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-363307
hdl:20.500.11880/32996
http://dx.doi.org/10.22028/D291-36330
ISSN: 1440-1746
0815-9319
Datum des Eintrags: 2-Jun-2022
Bezeichnung des in Beziehung stehenden Objekts: Supporting Information
In Beziehung stehendes Objekt: https://onlinelibrary.wiley.com/action/downloadSupplement?doi=10.1111%2Fjgh.14932&file=jgh14932-supp_0001.mpg
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Innere Medizin
Professur: M - Keiner Professur zugeordnet
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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