ASGE Masterclass: Endoscopic Retrograde Cholangiopancreatography (ERCP) Virtual | January 2022-Standard sphincterotomy and access sphincterotomy: how and how far to go

Video Transcription

Video Summary

In the video, the speaker discusses sphincterotomy techniques and considerations for difficult cannulations during ERCP procedures. He emphasizes the importance of expert cannulation technique as the foundation for expert sphincterotomy skill. Various techniques for sphincterotomy, including needle knife pre-cut, guff septotomy, and fistulotomy, are described. The speaker also discusses the use of ultra-tapered cannulas and thin guide wires for difficult cannulations. He emphasizes the need for careful alignment and proper anatomical knowledge to reduce the risk of complications. The speaker acknowledges that the evidence is still growing and heterogeneous, making it difficult to establish definitive guidelines. However, he suggests that sphincterotomy techniques guided by alignment and aim, tailored to the patient's needs, and performed by skilled operators have shown comparative success, safety, and efficiency. The speaker also discusses the importance of proper indications and preventative measures to reduce the risk of complications. Overall, the video aims to provide insights into sphincterotomy techniques and considerations, while acknowledging that individual operator expertise and patient characteristics should guide decision-making in clinical practice.

Keywords

sphincterotomy techniques

difficult cannulations

ERCP procedures

expert cannulation technique

needle knife pre-cut

guff septotomy

fistulotomy

ultra-tapered cannulas

thin guide wires