Journal of AdvancedMedical and Dental Sciences Research

Background and aim: Gaining access to the biliary duct is the most important step for a successful therapeutic biliary endoscopy. In the current study, we evaluated success and complication rates of a wire-guided trans-pancreatic sphincterotomy (TPS) for cannulating inaccessible common bile ducts at our institution. Methods: The study was conducted at a tertiary care referral center between January 2016 and December 2018.Consecutive patients with difficult biliary cannulation who underwent transpancreatic sphincterotomy to gain biliary access were included in the study and analyzed, retrospectively. Success rate for selective biliary cannulation (SBC) and adverse events associated with TPS were recorded. 1567 patients were referred to our department for ERCP. Results: A total of 1567 patients underwent ERCP for biliary indications during the study period. The success rate for primary cannulation techniques was 89%. TPS was utilized for SBC in 64 patients. Common bile duct cannulation was successfully achieved in 63 (98.4%) patients. One patient (1.56%) required a percutaneous transhepatic biliary drainage.There was no major adverse event. Minor adverse events were noticed in three patients (4.68%) including mild pancreatitis in 2 (3.12%) and mild intra-procedural bleeding in 1 (1.56%) patient. Conclusion: Trans-pancreatic sphincterotomy (TPS) is a safe and effective technique in patients with difficult biliary cannulation. Randomized trials are required comparing TPS with other techniques in future. Key words: Endoscopic retrograde cholangiopancreatography; Trans-pancreatic sphincterotomy (TPS); Needle-knifeprecut; Complications, Selective biliary cannulation (SBC).