Efficacy and safety of primary needle-knife fistulotomy in biliary cannulation

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hemant Raj Mutneja ◽  
Abhishek Bhurwal ◽  
Bashar M. Attar ◽  
Ishaan Vohra ◽  
Emmanuel Palomera Tejeda ◽  
...  
Keyword(s):  
Efficacy And Safety ◽  
Biliary Cannulation ◽  
Needle Knife

scholarly journals Initial experience with a homemade “hybrid-tome” for needle-knife precut in patients with difficult biliary cannulation

2021 ◽  
Vol 09 (11) ◽  
pp. E1611-E1616
Author(s):  
Emilio J. De la Morena Madrigal ◽  
Isabel Rodríguez García ◽  
Ana Belén Galera Ródenas ◽  
Elena Pérez Arellano
Keyword(s):  
Clinical Success ◽  
Clinical Success Rate ◽  
Objective Data ◽  
Efficacy And Safety ◽  
Duodenal Papilla ◽  
Technical Success ◽  
Biliary Cannulation ◽  
Improve Compliance ◽  
Difficult Biliary Cannulation ◽  
Needle Knife

Abstract Background and study aims Current clinical guidelines recommend needle-knife precut (NKP) as the primary and best method for performing a biliary cannulation (BC) when simple techniques fail and the criteria are met for difficult BC (DBC). However, many endoscopists avoid or defer early NKP in favor of alternative, simpler techniques that have not been shown to be either safer or more effective. Our goal is to test a device that provides the needle-knife papillotome (NKPT) with traction capability and which can facilitate the learning and execution of NKP. Patients and methods This was a descriptive bicentric observational study of a personal cohort of patients undergoing early NKP to analyse the efficacy and safety of the technique with a “hybrid-tome” (HT) built using the isolated core of a NKPT and a conventional canulotome. Results Over a 4-year period, we performed 43 NKPs with the HT, achieving BC in one or two steps in all cases. The 100 % technical success was matched by a 95 % clinical success rate. We recorded 11 adverse events (23 %): five hemorrhages, four pancreatitis, and two cholangitis. In addition to the objective data, we confirmed that HT facilitates alignment with the duodenal papilla and the execution of pre-cutting, especially if the papilla is intradiverticular or hidden by folds. Conclusions The HT tested seems to help trained endoscopists to perform NKP, especially in some anatomic situations, which can improve compliance with the guidelines recommended for early NKP in patients with DBC.

scholarly journals A Novel Round Insulated Tip Papillotome as an Alternative to the Classic Needle-Knife for Precut Sphincterotomy in Endoscopic Retrograde Cholangiopancreatography

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Birol Baysal ◽  
Hakan Akin ◽  
Omar Masri ◽  
Ali Tüzün İnce ◽  
Hakan Senturk
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Efficacy And Safety ◽  
Endoscopic Retrograde ◽  
Exclusion Criteria ◽  
Biliary Cannulation ◽  
Successful Cannulation ◽  
Significant Difference ◽  
Associated Conditions ◽  
Needle Knife ◽  
Precut Sphincterotomy

Objective. The purpose of this study was to investigate the efficacy and safety of a new round insulated tip papillotome (r-ITP) as compared to that of the classic needle-knife sphincterotome (NKS) in difficult-to-cannulate endoscopic retrograde cholangiopancreatography (ERCP) patients.Materials and Methods. Patients with no exclusion criteria and an intact papilla referred for ERCP were invited to participate in the study. “Difficult-to-cannulate” patients, defined as failure to achieve deep biliary cannulation within five minutes from the first touch of papilla, with no more than ten attempts permitted, were randomly assigned for precut sphincterotomy using either the classic NKS or r-ITP.Results. Seventy and 69 patients were randomly assigned to the NKS and r-ITP groups, respectively. The groups were comparable regarding age, sex, indications, and associated conditions. There was no statistically significant difference in terms of successful cannulation or post-ERCP complications between the two groups. Only five patients (3.6%) developed mild to moderate post-ERCP pancreatitis and two had mild bleeding. No perforations or deaths were encountered.Conclusions. Although the round insulated tip papillotome was not shown to be superior to the classic NKS concerning efficacy and safety when used by an experienced endoscopist, it remains a simple, safe, and efficacious alternative.

scholarly journals Biliary cannulation in endoscopic retrograde cholangiography: How to tackle the difficult papilla

2021 ◽  
Author(s):  
Mark op den Winkel ◽  
Jörg Schirra ◽  
Christian Schulz ◽  
Enrico N. De Toni ◽  
Christian J. Steib ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Guide Wire ◽  
A Priori ◽  
Endoscopic Retrograde Cholangiography ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Increased Risk ◽  
Difficult Biliary Cannulation ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

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.

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

2013 ◽  
Vol 58 (12) ◽  
pp. 3606-3610 ◽  
Author(s):  
Jian-hong Zhu ◽  
Qiang Liu ◽  
De-qing Zhang ◽  
Huang Feng ◽  
Wei-chang Chen
Keyword(s):  
Biliary Cannulation ◽  
Difficult Biliary Cannulation ◽  
Needle Knife

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.

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

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

scholarly journals Efficacy of single-incision needle-knife biopsy for sampling subepithelial lesions

2017 ◽  
Vol 05 (01) ◽  
pp. E5-E10 ◽  
Author(s):  
Yuto Shimamura ◽  
Jason Hwang ◽  
Maria Cirocco ◽  
Gary May ◽  
Jeffrey Mosko ◽  
...  
Keyword(s):  
Diagnostic Method ◽  
Single Incision ◽  
Efficacy And Safety ◽  
Tissue Samples ◽  
Specific Diagnosis ◽  
Needle Knife ◽  
Subepithelial Lesions ◽  
Upper Gastrointestinal ◽  
Diagnostic Biopsies ◽  
Made In

Abstract Background and study aims Single-incision needle-knife (SINK) biopsy is a diagnostic method for acquiring tissue samples for subepithelial lesions (SELs). A single linear incision is made in the overlying mucosa and tissue samples are obtained by passing conventional biopsy forceps through the opening and deep into the lesion. The aim of this study was to describe the efficacy and safety of this technique. Patients and methods Consecutive patients who underwent SINK biopsy for an upper gastrointestinal SEL between October 2013 and September 2015 were retrospectively reviewed. Results Forty-nine patients underwent 50 SINK biopsies. Sufficient sampling for a definite pathologic diagnosis was obtained in 42 (86 %) cases, with 91 % (40/44) having sufficient sample to perform immunohistochemistry when deemed clinically relevant. Of the 26 patients with prior non-diagnostic biopsies or FNA, a specific diagnosis was obtained in 85 % (22/26). There were no significant adverse events. Conclusions SINK biopsy is a safe and feasible strategy for obtaining a definitive tissue diagnosis with immunohistochemistry for SELs.

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.

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