RESUMEN

Background: Selective biliary cannulation (SBC) is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP). SBC has the potential to fail in as many as 20% of cases, even with skilled endoscopists. Precut incision techniques like needle-knife sphincterotomy (NKS) and transpancreatic septotomy (TPS) can be used in cases where standard cannulation techniques fail. However, these precut techniques may also fail in some cases. We aimed to evaluate the procedural success of the combined TPS + NKS technique in difficult biliary cannulation. Patients and methods: The study included 289 patients who underwent ERCP with precut techniques from 2017 to 2022. Patients were classified into the following three groups and evaluated retrospectively in terms of cannulation success, and ERCP-related adverse effects: Transpancreatic septotomy, NKS, and TPS + NKS; statistical package for the social sciences (SPSS), version 29.0, software was used to analyze the data. Results: The success rate of SBC was 69% in the TPS group, 75.3% in the NCS group, and 87% in the TPS + NCS group. There was no significant difference between the NKS and TPS + NKS groups. Cannulation success in both NKS group and NKS + TPS groups was significantly higher than in the TPS group (p < 0.001). Complication rates were similar. Conclusion: In cases where standard sphincterotomy and precut techniques fail, a second precut technique can be used. A previous TPS does not prevent NKS. How to cite this article: Abiyev A, Tuzcu B, Bilican G, et al. Combination of Precut Techniques in Difficult Biliary Cannulation. Euroasian J Hepato-Gastroenterol 2024;14(1):56-59.

RESUMEN

Alzheimer's disease (AD) is the most common cause of dementia in the elderly. Although AD treatment is still insufficient despite all the recent developments, detection and treatment in the early stage of disease have provided more clinical benefits. Objective: In this study, we aimed to use the critical flicker fusion (CFF) threshold test to diagnose AD in the early stage. Methods: In this study, 120 patients (above 65 years of age) and 50 control groups who were admitted to geriatrics outpatient clinic and diagnosed in early- and middle-stage AD were included. The remaining 58 patients and 25 healthy volunteers underwent comprehensive geriatric assessment and CFF testing. Results: The mean CFF value of AD group was significantly lower than the control group (36.44±7.00 vs. 44.24±3.82, p<0.001, respectively). There was a significant difference in standardized mini-mental state examination (MMSE) score in both groups (18.05±5.25 vs. 25.96±2.85, p<0.001, respectively). There was also a positive correlation between CFF value and MMSE score (p<0.001, r=0.459). Thirty-four patients were in the early-stage AD group and 24 patients were in the middle-stage AD group. There was a significant difference in CFF values between the three groups when we compared the patients in early- and middle-stage AD and control groups (p<0.001). The mean CFF values in patients with early- and middle-stage AD were 37.93±7.33 and 34.97±7.43, respectively. The mean age, gender, education level, and the number of drugs used did not show a statistically significant difference in both groups (p>0.05). The cutoff value for the CFF variable was determined as 39 Hz [p<0.001; area under the curve (AUC)=0.852; sensitivity=70.69% (95% confidence interval [95%CI] 57.3-81.9); specificity=92.00% (95%CI 74.00-99.00)]. Conclusions: There is a significant difference in mean CFF values between AD and healthy groups. CFF testing may play an important role in diagnosing AD in the early stage.

A doença de Alzheimer (DA) é a causa mais comum de demência em idosos. Embora o tratamento da DA ainda seja insuficiente mesmo com todos os desenvolvimentos recentes, a detecção precoce e o tratamento no estágio inicial da doença têm demonstrado maior benefício clínico. Objetivo: Neste estudo, nosso objetivo foi usar o teste Critical Flicker Fusion Threshold (CFF) para diagnosticar a DA em estágio inicial. Métodos: Foram incluídos 120 pacientes e 50 controles em ambulatório de geriatria, com diagnóstico de DA inicial e moderada e acima de 65 anos. Os 58 pacientes restantes e 25 voluntários saudáveis foram submetidos a avaliação geriátrica abrangente e ao CFF. Resultados: A média de CFF do grupo AD foi significativamente menor do que a do grupo controle (36,44±7,00 vs. 44,24±3,82, p<0,001, respectivamente). Houve diferença significativa na pontuação do Miniexame do Estado Mental (MMSE) em ambos os grupos (18,05±5,25 vs. 25,96±2,85, p<0,001, respectivamente). Também houve correlação positiva entre o valor CFF e o escore MMSE (p<0,001, r=0,459). Trinta e quatro estavam no estágio inicial e 24 estavam no estágio moderado do grupo DA. Houve diferença significativa nos valores de CFF entre os três grupos quando comparamos os pacientes com DA inicial e moderada e os grupos controle (p<0,001). O valor médio de CFF em pacientes com DA em estágio inicial foi de 37,93±7,33 e de 34,97±7,43 nos pacientes em estágio moderado. As médias de idade, sexo, escolaridade e número de medicamentos usados não apresentaram diferença estatisticamente significativa entre os dois grupos (p>0,05). O valor de corte para a variável CFF foi determinada como 39 Hz (p<0,001; área sob a curva ­ AUC=0,852; sensibilidade=70,69% [intervalo de confiança de 95%­ IC95% 57,3­81,9]; especificidade=92,00% [IC95% 74,00­99,00]). Conclusões: Há diferença significativa entre os valores médios de CFF do grupo de DA e do grupo saudável. O CFF pode desempenhar um papel importante no diagnóstico de DA no estágio inicial.