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Surgical Endoscopy

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01-12-2016

Needle-knife papillotomy and fistulotomy improved the treatment outcome of patients with difficult biliary cannulation

Authors: Qi-Sheng Zhang, Bing Han, Jian-Hua Xu, Peng Gao, Yu-Cui Shen

Published in: Surgical Endoscopy | Issue 12/2016

Abstract

Background and aims

Needle-knife papillotomy and fistulotomy (NKPF) is a new, modified technique designed for difficult biliary cannulation. The safety and efficacy of performing NKPF based on characteristics of main duodenal papilla (MDP) was evaluated.

Methods

We performed a retrospective review of consecutive patients with intact papilla who were established as candidates for therapeutic ERCP at tertiary referral center. A total of 532 patients were included in conventional endoscopic retrograde cholangiopancreatography (ERCP) group in which repeated cannulation was tried in patients with difficult bile duct cannulation; and 598 patients enrolled in early NKPF group according to predefined parameters. Based on the characteristics of MDP, different types of NKPF were performed. The endoscopic data (mean procedure time, anatomy of the main papilla), rate of cannulation success, and post-ERCP complications were collected.

Results

A total of 82 patients underwent NKPF. The mean procedure time of the small papilla group was longer than bulging papilla group (P < 0.05). The success rate of biliary cannulation in the small papilla group (69.3 %) was lower than in the bulging papilla group (100 %, P < 0.01). The overall successful biliary cannulation of patients in the NKPF group was significantly higher than in the conventional group (98.8 vs 90.8 %, P > 0.05). The total complication rate was 6.6 % among conventional group patients and 5.7 % among NKPF group, respectively. The overall complication rate and rates of specific complications (pancreatitis, bleeding, cholangitis, and perforation) in the two groups were similar (P > 0.05).

Conclusion

Early NKPF based on characteristics of MDP raised the success rate of biliary cannulation when conventional cannulation failed and did not increase the complication rate post-ERCP. Clinic Trials. gov number, Hongwei-1102-12.

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Title: Needle-knife papillotomy and fistulotomy improved the treatment outcome of patients with difficult biliary cannulation
Authors: Qi-Sheng Zhang
Bing Han
Jian-Hua Xu
Peng Gao
Yu-Cui Shen
Publication date: 01-12-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 12/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-4914-x

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Springer Medicine

Needle-knife papillotomy and fistulotomy improved the treatment outcome of patients with difficult biliary cannulation

Abstract

Background and aims

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background and aims

Methods

Results

Conclusion

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