Transpancreatic sphincterotomy... a technique to aid in difficult biliary cannulation Published evidence suggest it is safe and effective However, many experts feel cutting through pancreatic sphincter is risky and/or unnecessary Views #GITwitter? How many use this technique?

@amolbapaye @DouglasAdlerMD @EHolzwanger @NEndoscopy @pbendoscopist @helpatologist @AEMLondon @sachdevmd @neilRsharmaMD @AgnihotriGI @ChahalPrabhleen @BilalMohammadMD @krishnanendo @Taalamri @drkeithsiau @stevenbollipo @DrSalihTokmak @DannyIssaMD @CaptCholangio

Nice demonstration...I consider TPS early if DGW fails twice; I will go straight to TPS...ESGE recommends that in patients with a small papilla that is difficult to cannulate, trans pancreatic biliary sphincterotomy should be considered if unintentional insertion of a guidewire into the pancreatic duct occurs..

That is the perfect setting to use TPS I am a big fan of precut, but with a small papilla, TPS is simpler and faster Plus saves time in not having to switch to needle knife and back

We use this routinely and have been using this technique for years. It’s very safe and effective 👍

Nicely done! I did a thread on this 🧵 Definitely a useful tool in the toolbox 🧰

Yeah don’t use this much at all. No fear for cutting pancreatic sphincter as do plenty of panc cases. Much prefer double wire and gets me in almost every time. Otherwise PD stent then in…

@EHolzwanger I was trained that the Goff was an absolute no go for fear of complications and medico legal risks but the data really does support it’s safety and use.

Not a user of tps . As others have noted, prefer double wire or precut. No long term data one way or another, just personal approach

I think data pretty clearly supports the use. If I go PD I usually do DGW ▶️ PD stent ▶️ needle knife over PD stent. However I think Goff is reasonable and safe too.

This is our primary go to technique. Rarely use DGW but prefer TPS + pancreatic stent if the wire goes to PD accidentally. Then cannulate at the left upper quadrant from the Stent. It works almost all the time. We don't see higher PEP and the PEPs are not after TPS.