OUTCOMES OF NEEDLE KNIFE FISTULOTOMY AS AN INITIAL METHOD OF BILIARY CANNULATION

Background: In the setting of a naïve papilla, biliary cannulation is a key step in successfully performing endoscopic retrograde cholangiography (ERC). Difficult biliary cannulation (DBC) is associated with an increased risk of post-ERCP-pancreatitis and failure of the whole procedure. Summary: Recommendations for biliary cannulation can be divided in (a) measures to reduce the likelihood of a difficult papilla-situation a priori and (b) rescue techniques in case the endoscopist is actually facing DBC. (a): careful inspection of the papillary anatomy and optimizing its accessibility by scope-positioning is fundamental. A sphincterotome in combination with a soft-tip hydrophilic guide-wire rather than a standard catheter with a standard guide-wire should be used. (b): The most important rescue techniques are needle-knife precut, double-guidewire technique and transpancreatic sphincterotomy. In few cases, anterograde techniques are needed. To this regard, the EUS-guided biliary drainage (EUS-BD) followed by rendezvous is increasingly used as an alternative to percutaneous-transhepatic biliary drainage. Key Messages: Biliary cannulation can be accomplished with alternative retrograde or less frequently by salvage-anterograde techniques, once conventional direct cannulation attempts have failed. Considering recent favorable data for the early use of transpancreatic sphincterotomy, an adopted version of the 2016 European-Society-for-Gastrointestinal-Endoscopy (ESGE)-algorithm on biliary cannulation is proposed.

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Evaluation of Early Precut with Needle-Knife in Difficult Biliary Cannulation During ERCP

Digestive Diseases and Sciences ◽

10.1007/s10620-013-2834-3 ◽

2013 ◽

Vol 58 (12) ◽

pp. 3606-3610 ◽

Cited By ~ 4

Author(s):

Jian-hong Zhu ◽

Qiang Liu ◽

De-qing Zhang ◽

Huang Feng ◽

Wei-chang Chen

Keyword(s):

Biliary Cannulation ◽

Difficult Biliary Cannulation ◽

Needle Knife

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Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

Frontline Gastroenterology ◽

10.1136/flgastro-2019-101380 ◽

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.

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211 Comparative Efficacy of the Iso-Tome ® Precut Versus Needle-Knife Precut Fistulotomy in Cases of Difficult Biliary Cannulation

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2017.03.065 ◽

2017 ◽

Vol 85 (5) ◽

pp. AB60

Author(s):

Su Jung Han ◽

Tae Hoon Lee ◽

Sang-Heum Park ◽

Hyun Jong Choi ◽

Yun Nah Lee ◽

...

Keyword(s):

Comparative Efficacy ◽

Biliary Cannulation ◽

Difficult Biliary Cannulation ◽

Needle Knife

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Tu1545 Fast and Safe Needle-knife Precut Papillotomy With Layer-By-Layer Incision in Difficult Biliary Cannulation May Not Require Pancreatic Stent Placement

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2016.03.1252 ◽

2016 ◽

Vol 83 (5) ◽

pp. AB603

Author(s):

Akito Iwasaki ◽

Yuri Kato ◽

Takamitsu Sato ◽

Kunihiro Hosono ◽

Atsushi Nakajima ◽

...

Keyword(s):

Stent Placement ◽

Layer By Layer ◽

Pancreatic Stent ◽

Biliary Cannulation ◽

Difficult Biliary Cannulation ◽

Needle Knife

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

10.21203/rs.2.15791/v2 ◽

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.

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