Outcome of access sphincterotomy using a needle knife converted from a standard biliary sphincterotome

Cannulation fails in up to 10 % of all endoscopic retrograde cholangiopancreatographies (ERCPs). A standard sphincterotome can be converted to a needle knife to perform precut sphincterotomy (PCS). In this retrospective study, we analyzed cannulation rates, adverse events, and the percentage of patients requiring a second sphincterotome using a converted needle knife. Over a 7-year period, 3322 ERCPs were performed by one experienced therapeutic endoscopist; 1487 sphincterotomies were performed, 78 precut sphincterotomies using a converted needle knife. Successful cannulation using the converted needle knife was achieved in 96 % of cases at the initial procedure. Adverse events occurred in 17 % and post-ERCP pancreatitis was reported in 10 % of patients. A second sphincterotome was needed in 13 % of cases. This study shows a converted needle knife can be used for successful cannulation of either the biliary or the pancreatic duct after a failed cannulation with a standard sphincterotome, with a low percentage of adverse events anda reduction in the need for accessories.

• References

• 1 Bourke MJ, Costamagna G, Freeman ML. Biliary cannulation during endoscopic retrograde cholangiopancreatography: core technique and recent innovations. Endoscopy 2009; 41: 612-617
• 2 Bailey AA, Bourke MJ, Williams SJ et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy 2008; 40: 296-301
• 3 Herreros de Tejada A, Calleja JL, Diaz G et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009; 70: 700-709
• 4 Cote GA, Ansstas M, Pawa R et al. Difficult biliary cannulation: use of physician-controlled wire-guided cannulation over a pancreatic duct stent to reduce the rate of precut sphincterotomy (with video). Gastrointest Endosc 2010; 71: 275-279
• 5 Kaffes AJ, Sriram PV, Rao GV et al. Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc 2005; 62: 669-674
• 6 Misra SP. Pre-cut sphincterotomy: does the timing matter?. Gastrointest Endosc 2009; 69: 480-483
• 7 Silverman WB. Simple method for making triple-lumen needle-knife papillotome. Gastrointest Endosc 1996; 43: 264
• 8 Pai CG. Precut papillotomy using needle knife fashioned from discarded standard papillotomes. Indian J Gastroenterol 2000; 19: 116-118
• 9 Abu-Hamda EM, Baron TH, Simmons DT et al. A retrospective comparison of outcomes using three different precut needle knife techniques for biliary cannulation. J Clin Gastroenterol 2005; 39: 717-721
• 10 Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
• 11 Binmoeller KF, Seifert H, Gerke H et al. Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation. Gastrointest Endosc 1996; 44: 689-695
• 12 Deng DH, Zuo HM, Wang JF et al. New precut sphincterotomy for endoscopic retrograde cholangiopancreatography in difficult biliary duct cannulation. World J Gastroenterol 2007; 13: 4385-4390
• 13 Harewood GC, Baron TH. An assessment of the learning curve for precut biliary sphincterotomy. Am J Gastroenterol 2002; 97: 1708-1712
• 14 Cennamo V, Fuccio L, Zagari RM et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials.. Endoscopy 2010; 42: 381-388