Together we shape the future of HPB

Supporting a​ smooth path to​ luminal access –​ even in the most​ challenging cases

The importance of luminal access ​

Autocap CU

Luminal access to the biliary and pancreatic ducts remains a cornerstone to the success of ERCP procedures. Without the ability to reach the relevant target, it becomes difficult to diagnose and/or perform therapeutic maneuvers.​

​Thus, overcoming challenges in ductal access may contribute to improving ERCP outcomes. ​

Challenges to luminal access and risk of complications remain a part of HPB endoscopy

The hepato-pancreato-biliary (HPB) system is characterized by multiple ducts, branching out in close proximity of one another.​

Despite 5 decades of improved duodenoscopes and accessories, deep cannulation of the desired duct in a native papilla remains the most challenging step to successful completion of the ERCP procedure.¹

​How to best achieve a safe and effective bile duct cannulation during ERCP has always been, and still is, a much-debated issue. Both technical and patient-related aspects of cannulation and cannulation difficulties have previously been investigated.²

​Surgically altered HPB anatomy may also introduce additional challenges to successful cannulation.3 These challenges can result in repeat procedures, delayed therapy, and increased costs.4 To overcome them, thoughtful and innovative solutions are needed.​

Luminal access-related ERCP complications are well-documented5,6

3,5%-9,7% Post-ERCP pancreatitis⁵

rising to 14,7% in high-risk patients​

1,5% ERCP-related perforation⁶

1,3% Bleeding⁵

29% of these cases are severe

1,4% Infection⁵

(including cholangitis and cholecystitis)

A holistic approach to the HPB (hepato-pancreato-biliary) pathway​

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​1. Hawes RH, Devière J. How I cannulate the bile duct. Gastrointest Endosc. 2018;87:1-3.​

​2. Haraldsson E, Kylänpää L, Grönroos J, et al. Macroscopic appearance of the major duodenal papilla influences bile duct cannulation: a prospective multicenter study by the Scandinavian Association for Digestive Endoscopy Study Group for ERCP. Gastrointest Endosc. 2019;90(6):957-963.​

​3. Krutsri C, Kida M, Yamauchi H, et al. Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy. World J Gastroenterol. 2019;25(26):3313-3333.​

​4. Deprez PH, Garces Duran R, Moreels T, et al. The economic impact of using single-operator cholangioscopy for the treatment of difficult bile duct stones and diagnosis of indeterminate bile duct strictures. Endoscopy. 2018;50(2):109-118.​

​5. Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(2):127–149.​

​6. Patil NS, Solanki N, Mishra PK, et al. ERCP-related perforation: an analysis of operative outcomes in a large series over 12 years. Surg Endosc. 2020;34(1):77–87.​

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