Difficult Selective Biliary Cannulation (SBC)
Factors associated with difficult SBC:
- SMALL PAPILLA: can be difficult to identify, when + excessive mucosal folds, when + architectural distortions, the tip of the ST may be too large, associated with initial contact of the ST with the septum instead of smooth insertion into the BD
- EXTRA LARGE PAPILLA: can be more relaxed and unstable, the larger the papilla the more difficult further cannulation is, even with successful initial ST-papilla contact.
- LOCATION OF THE PAPILLA: when in the 3rd duodenal portion, more proximally or distally
- PARARELL tract of the MPD & CBD: difficult to pick up the correct tract, It's sometimes beneficial to inject
contrast to better visualize the anatomy
- PAD: can obscure the papilla or distort its orientation, no need to angulate the ST upward (the
BD direction runs horizontally), If unsuccessful -> standard catheter
- ALTERED ANATOMIES: Billroth II gastrectomy / Roux-en-Y surgery, typically papilla in a portion of the duodenum retrograde from the gastrojejunotomy site
- OTHERS: biliary malignancies, tumour infiltration of the papilla or duodenum, malignancy makes the cystic tracts and vasculature=more friable
Dr. Katarzyna Monika Pawlak @KM_Pawlak
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