ERC CLIP WITH LINE – A GERMAN PILOT SERIES

Aims:

Duodenal diverticulum (DD) is a frequent condition that is described in up to 20% of endoscopically retrograde cholangiopancreatography (ERCP)¹. Large DD with intradiverticular located Papilla vateri (PV) have a lower incidence², but the exploratiuon and treatment of biliary tract (BT) can be difficult and shows significantly higher complication rates². In 2016 the ERC Clip With Line Technique (ECLT) developed by our group as part of a method transfer from the ESD³ and was present for the first time in 2016. To visualize the PV in cases of large DD we attached dental floss via a haemoclip to the papillary roof and the line was pulled out via the mouth. Traction on the diverticular collum makes it easier to visualize/cannulate the PV.

Methods:

Therapy success and complication rate of ECLT, as a feasibility study. Retrospective case series review of the ECLT accomplished in our center between 24.8.16 and 27.4.18.

Results:

ECLT was used in 5 patients (3 women) with large DD, where the primary cannulation of BT was not feaseble with standard techniques. Mean patient age 74.6 years (min 59yr, max 88yr, SD 12.5). Average examination time 125 min (min 30 min, max 235 min, SD 87.9). Mean hospitalization after ECLT 4 days (min 2 d, max 5 d, SD 1.4). The cannulation of BT succeeded in all cases. There were no complications. Very experienced (more than 10,000 ERCs) and less experienced investigators performed ECLT.

Conclusions:

ECLT proves to be a safe method. ECLT is easy to perform/learn. It is a cost effective way to visualize/treat the PV for large DD. Despite the positive trend, a larger number of examinations is required and the procedures needs to be performed according to a standardized protocol in order to be sure about success rates, complications and possibly shortened procedure time.