scholarly journals Management of biliary diseases after the failure of initial needle knife precut sphincterotomy for biliary cannulation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min-Hao Lo ◽  
Cheng-Hui Lin ◽  
Chi-Huan Wu ◽  
Yung-Kuan Tsou ◽  
Mu-Hsien Lee ◽  
...  
Keyword(s):  
Bile Duct ◽  
Alternative Therapy ◽  
Length Of Hospital Stay ◽  
Time Interval ◽  
Significant Finding ◽  
Invasive Treatment ◽  
Biliary Cannulation ◽  
Needle Knife ◽  
Duct Stricture ◽  
Precut Sphincterotomy

AbstractEndoscopic retrograde cholangiopancreatography is not always successful even with needle knife precut sphincterotomy (NKPS). How to manage these patients with initial NKPS failure has not been well studied. We report the outcomes of patients who received endoscopic and non-endoscopic rescue treatment after the initial NKPS failure. During the 15 years from 2004 to 2018, 87 patients with initial NKPS failure received interval endoscopic treatment (IET group, n = 43), percutaneous transhepatic biliary drainage (PTBD group, n = 25), or bile duct surgery (BDS group, n = 19) were retrospectively studied. Compared with the PTBD group, the prevalence of choledocholithiasis was higher (69.8% vs. 16.0%, p < 0.001), and malignant bile duct stricture were lower (20.9% vs. 76.0%, p < 0.001) in the IET group. Furthermore, the IET group had a significantly longer time interval between the first and second treatment procedures (4 days vs. 2 days, p = 0.001), a lower technique success rate (79.1% vs. 100%, p = 0.021), and a shorter length of hospital stay (7 days vs. 18 days, p < 0.001). Compared to the BDS group, the only significant finding was that the patients in the IET group were older. Although not statistically significant, the complication rate was lowest in the IET group (7.0%) while highest in the BDS group (15.8%). Complications in the IET group were also mild, as compared with the other two groups. In conclusion, IET should be considered after initial failed NKPS for deep biliary cannulation before contemplating more invasive treatment such as BDS. PTBD may be the alternative therapy for patients with malignant biliary obstruction.

scholarly journals Transpancreatic Precut Sphincterotomy for Biliary Access: The Relation of Sphincterotomy Size to Immediate Success Rate of Biliary Cannulation

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Lien-Fu Lin
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Success Rate ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
The Other ◽  
Pancreatic Stent ◽  
Biliary Cannulation ◽  
Needle Knife ◽  
Precut Sphincterotomy

Background. Transpancreatic precut sphincterotomy (TPS) is an option for difficult common bile duct (CBD) access, and the reports are few, with immediate success rate varying from 60 to 96%. The description of relation between the size of TPS and the immediate success rate of CBD cannulation was not found in the literature. The Aim of the Study. To evaluate the relation of large TPS to immediate success rate of CBD cannulation. Methods. A retrospective analysis was performed in prospectively collected data of 20 patients. TPS was performed with traction papillotome in the main pancreatic duct (MPD) directing towards 11 o’clock. Needle knife (NK) was used to enlarge TPS in five patients, and the other 15 cases had large TPS from the beginning of sphincterotomy. Prophylactic pancreatic stent was inserted in 18 cases, with diclofenac given in 12 cases. Results. The immediate success rate of CBD cannulation was 90% and with an eventual success rate of 100%. The failure in one immediate CBD cannulation with large TPS was due to atypical location of CBD orifice, and the other failed immediate CBD cannulation was due to inadequate size of TPS. Complications included 3 cases of post-TPS bleeding and 3 cases of mild pancreatitis. Conclusion. TPS is an effective procedure in patients with difficult biliary access and can have high immediate success rate with large TPS.

scholarly journals Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

2020 ◽  
pp. flgastro-2019-101380
Author(s):  
Jared Rejeski ◽  
Marc Hines ◽  
Jason Jones ◽  
Jason Conway ◽  
Girish Mishra ◽  
...  
Keyword(s):  
High Volume ◽  
Complication Rates ◽  
Success Rates ◽  
Biliary Cannulation ◽  
Pancreatic Duct Stenting ◽  
Significant Difference ◽  
Effective Option ◽  
Needle Knife ◽  
Precut Sphincterotomy ◽  
Rectal Indomethacin

GoalsOur study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.BackgroundComplication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.StudyWe performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.ResultsWe identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p<0.001).ConclusionThis data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.

scholarly journals A simple and novel marking method for correctly identifying the precutting direction to achieve safe and efficacious precut sphincterotomy (with video)

2019 ◽  
Vol 07 (01) ◽  
pp. E3-E8
Author(s):  
Kazumasa Nagai ◽  
Akio Katanuma ◽  
Kuniyuki Takahashi ◽  
Kei Yane ◽  
Toshifumi Kin ◽  
...  
Keyword(s):  
Bile Duct ◽  
Technical Success ◽  
Tertiary Referral ◽  
Endoscopic Retrograde ◽  
Incision Length ◽  
Tertiary Referral Center ◽  
Preliminary Study ◽  
Needle Knife ◽  
The Right ◽  
Precut Sphincterotomy

Abstract Background and study aims Failure to recognize the right direction and precise incision length during precutting has been reported. To address these concerns, we developed a marking method that places a marking on the cutting endpoint before starting precutting. This preliminary study aimed to assess the effectiveness and safety of precut sphincterotomy using our new marking method. Patients and methods Between April 2015 and May 2017, 21 patients from our tertiary referral center were included in this study. Precut sphincterotomy using our marking method was employed for difficult common bile duct cannulation cases. Before starting precutting, a marking was placed slightly before the upper margin of the bulge of the papilla in the 11- to 12-o’clock direction as a cutting endpoint by cauterization with a needle knife. Results Technical success was obtained in all 21 procedures. There were no post-endoscopic retrograde cholangiopancreatography (ERCP) complications except for one mild case of post-ERCP pancreatitis. Conclusion Our new marking method before precutting enabled precise incision and quick bile duct cannulation without causing severe complications.

scholarly journals Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

2020 ◽  
Author(s):  
Kai-Shun Liang ◽  
Chieh-Chang Chen ◽  
Wei-Chih Liao ◽  
Yu-ting Kuo ◽  
Liang-Wei Tseng ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bile Duct ◽  
Adverse Events ◽  
Success Rate ◽  
University Hospital ◽  
Access Methods ◽  
Biliary Cannulation ◽  
Access Rate ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

Abstract Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF. Aims To investigate the success rate and complications of NKF and TPS in patients with difficult biliary access. Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed. Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred. Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.

scholarly journals Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

2019 ◽  
Author(s):  
Kai-Shun Liang ◽  
Chieh-Chang Chen ◽  
Wei-Chih Liao ◽  
Yu-ting Kuo ◽  
Liang-Wei Tseng ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bile Duct ◽  
Adverse Events ◽  
Complication Rate ◽  
University Hospital ◽  
Access Methods ◽  
Biliary Cannulation ◽  
Access Rate ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

Abstract Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF. Aims To investigate the success rate and complications of NKF and TPS in patients with difficult biliary access. Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, succesfs rate of biliary cannulation, and the rate of adverse events were assessed. Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred. Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.

scholarly journals DIFFICULT BILIARY CANNULATION: SHOULD WE ALWAYS TRY A SECOND ERCP AFTER A FAILED NEEDLE-KNIFE FISTULOTOMY?

2021 ◽  
Vol 58 (4) ◽  
pp. 509-513
Author(s):  
Victor Kalil FLUMIGNAN ◽  
Marina Garcia SEIKE ◽  
Victória Soares de SOUZA ◽  
Matheus Iguera CIRQUEIRA ◽  
Ana Beatriz SILVA ◽  
...  
Keyword(s):  
Bile Duct ◽  
Adverse Events ◽  
Success Rate ◽  
Short Interval ◽  
Normal Position ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Difficult Biliary Cannulation ◽  
Needle Knife ◽  
A Minor

ABSTRACT BACKGROUND: A successful bile duct cannulation is a prerequisite for the realization of endoscopic retrograde cholangiopancreatography (ERCP). When biliary cannulation is not possible, needle-knife fistulotomy (NKF) can be performed. However, when biliary access is not successfully achieved even after performing NKF, it is possible to interrupt the procedure, and repeat the ERCP after a short interval. OBJECTIVE: The aim of this study is to analyze if repeating an ERCP after a short interval of 48 hours is effective in achieving biliary access after an initial NKF was unsuccessfully performed. METHODS: A total of 1024 patients with a naive papilla, that underwent ERCP between the years of 2009-2019, were retrospectively reviewed. Difficult biliary cannulation was identified in 238 of these cases and NKF was performed. Success of biliary cannulation, NKF success at the first and second ERCPs, the associations between the type of the papilla, biliary dilatation, and overall success of NKF and adverse events rates were evaluated. RESULTS: Biliary access was initially achieved in 183 (76.8%) cases. Of the 55 (23.1%) remaining cases a second attempt was performed after 48 hours, and biliary access was successfully achieved in 46 (83.6%) of them. The overall success of NKF after the first and second ERCP, the success rate was 96.2%. Papilla located out of its normal position was related to a minor chance of success at NKF (P<0.05). CONCLUSION: We conclude that when biliary access is not achieved after the performance of a NKF, a second attempt is safe and effective and should be attempted.

scholarly journals Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

2020 ◽  
Author(s):  
Kai-Shun Liang ◽  
Chieh-Chang Chen ◽  
Wei-Chih Liao ◽  
Yu-ting Kuo ◽  
Liang-Wei Tseng ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Bile Duct ◽  
Adverse Events ◽  
Pancreatic Duct ◽  
Complication Rate ◽  
University Hospital ◽  
Biliary Cannulation ◽  
Access Rate ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

Abstract Background Selective deep biliary cannulation is the first and the most important step before further biliary therapy. Transpancreatic sphincterotomy(TPS), and needle knife fistulotomy(NKF) were commonly used in patients with difficult cannulation, but few studies compare the outcome between TPS and NKF.Methods A total of 78 patients who met the criteria of difficult cannulation in the National Taiwan University hospital from October 2015 to October 2017 were retrospectively reviewed. Their baseline demographics, success rate of biliary cannulation, and the rate of adverse events were assessed.Results 31 patients and 47 patients underwent TPS and NKF for difficult biliary access, respectively. The characteristics of the 2 groups were similar, but patients in TPS group had more frequent pancreatic duct cannulation. Bile duct cannulation was successful in 23 patients (74.2 %) in the TPS group and 39 (83.0%) in the NKF group (P=0.34). There was no difference between the TPS and NKF in the rate of adverse events, including post-ERCP pancreatitis (PEP) (16.1% vs. 6.4%, p = 0.17), and hemorrhage (3.2% vs. 8.5%, p = 0.35). No perforation occurred.Conclusions Both TPS and NKF have good biliary access rate in patient with difficult cannulation. TPS has acceptable successful rate and similar complication rate, compared with NKF.

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