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01-03-2008

Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

Authors: Hirotoshi Fukatsu, Hirofumi Kawamoto, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Yuko Okamoto, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kohsaku Sakaguchi

Published in: Surgical Endoscopy | Issue 3/2008

Abstract

Background

Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors.

Methods

Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP.

Results

For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34–3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52–15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55–22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21– 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis.

Conclusions

Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

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Title: Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors
Authors: Hirotoshi Fukatsu
Hirofumi Kawamoto
Hironari Kato
Ken Hirao
Naoko Kurihara
Takashi Nakanishi
Osamu Mizuno
Yuko Okamoto
Tsuneyoshi Ogawa
Etsuji Ishida
Hiroyuki Okada
Kohsaku Sakaguchi
Publication date: 01-03-2008
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 3/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-007-9473-8

At a glance: The STEP trials

Springer Medicine

Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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