Work

Technical factors associated with biliary cannulation success after transpancreatic precut sphincterotomy

Year: 2026

Type: article

Abstract: Background and study aims: Transpancreatic precut sphincterotomy (TPS) is a rescue technique for difficult biliary cannulation, but the factors associated with its success remain incompletely defined. In this study, patient-related and technical variables associated with biliary access after TPS were evaluated. Methods: We retrospectively reviewed 92 endoscopic retrograde pancreatography (ERCP) procedures requiring TPS between 2016 and 2023. Because additional incisions could be created after unsuccessful attempts, a total of 115 TPS sessions were analyzed. Patient characteristics and technical parameters, including papilla morphology, incision extent, and exposure, were assessed. Incision extent was categorized using the midpoint of the papillary oral protrusion as a visual landmark and the post-TPS orientation of bile and pancreatic orifices was documented. Results: = 0.010). At the ERCP level, initiating TPS with a long/full incision was associated with a higher first incision cannulation rate and shorter cannulation time without an increase in adverse events. After the TPS, the bile duct orifice was most often located in the upper-left region of the pancreatic orifice with a distance less than two sphincterotome widths (65.9%). Conclusions: TPS outcomes are associated mainly with technical factors, with type 2 papillae showing reduced success. Longer incisions were associated with higher biliary access rates and the bile duct orifice typically was upper-left of the pancreatic orifice after TPS.

Source: Endoscopy International Open

DOI: 10.1055/a-2863-1217