Selective bile duct intubation is the key and most difficult technique in the specific operation of endoscopic retrograde cholangiopancreatography (ERCP).
However, for beginners, selective bile duct intubation not only has a low success rate, but also increases the corresponding complications, which makes many doctors who learn ERCP slow to improve their skills.
We used double guide wire combined with papillary sphincter pre-incision technique for selective bile duct intubation, and summarized the success rate and complications.
Conventional bile duct intubation adopts the guide wire-assisted pull-type knife intubation method, and the corresponding diagnosis and treatment are carried out after successful intubation.
For patients with first failure of conventional selective bile duct intubation, and the guide wire can enter the pancreatic duct, bile duct intubation was performed with double guide wire combined with papillary sphincter pre-incision technique.
The specific method is: 0.035 macular guide wire guides the papillotomy knife into the pancreatic duct, then pre-cuts the papilla with mixed current or pure cutting current along the direction of the bile duct. Intra-tube exchange guide wire.
Then, under the guidance of another 0.035 macular super-smooth guide wire, the opening of the bile duct was found again at the upper left of the opening of the pancreatic duct, and the bile duct was selectively intubated. After success, the corresponding diagnosis and treatment were carried out.
ERCP is an important method for the diagnosis and treatment of biliary and pancreatic diseases. The emergence of ERCP technology is a revolution in the history of endoscopic development. It partially replaces traditional surgery and provides a more minimally invasive treatment method for patients with pancreatic and pancreatic diseases.
In clinical practice, the technical basis of ERCP is selective cholangiopancreatic intubation, of which selective bile duct intubation is the most commonly used, which is the basis for the successful completion of ERCP, but the success rate is not high.
The success rate of ERCP and the occurrence of complications depend on the operator's experience and skills. For patients who fail selective bile duct intubation with ERCP guidewire, some doctors use the technique of papillary sphincter pre-incision to achieve the purpose of deep bile duct intubation.
Some doctors also use the double guide wire method for selective bile duct intubation. Our experience is that the two techniques are skillfully combined to further improve the success rate of ERCP selective bile duct intubation.
In clinical work, we found that due to anatomical reasons, the pancreatic duct cannulation is relatively simple, and if the pancreatic duct is entered for the first intubation, it is often easy to enter the pancreatic duct when it is intubated again.
For patients with difficult ERCP selective bile duct intubation and the ERCP guidewire can enter the pancreatic duct, we use double guide wire combined with papillary sphincter pre-incision technique to achieve the purpose of deep bile duct intubation and improve the success rate of ERCP diagnosis and treatment.
The advantages of this method are:
1. The indwelling guide wire in the pancreatic duct can control the nipple in the center of the field of vision, so that the nipple can be better exposed and fixed, especially for the nipple located at the edge of the diverticulum, the position of the nipple is fixed, and the intubation in the direction of the bile duct becomes easier.
2. According to the direction of the reference pancreatic duct guide wire, it is easy to judge the direction of the bile duct, and it is easier to choose the direction of the bile duct intubation.
Generally, the angle between the bile duct and the ERCP guidewire in the pancreatic duct is about 15-20°, and the bile duct is located at 11 o'clock on the upper left of the pancreatic duct.
3. Papillary sphincter pre-incision separates the bile duct from the pancreatic duct opening in most patients, which not only improves the success rate of bile duct intubation, but also causes less damage to the pancreatic opening.
In conclusion, for patients with difficult ERCP bile duct intubation and the guide wire can enter the pancreatic duct, the use of double ERCP guidewires combined with papillary sphincter pre-incision technique can improve the success rate of intubation without increasing the occurrence of postoperative complications, which is worthy of clinical recommendation and use.