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DOI: 10.1055/s-0043-1765249
Needle Knife Fistulotomy Versus Partial Ampullary Endoscopic Mucosal Resection for Difficult Biliary Cannulation: a prospective randomised controlled trial
Authors
Aims Cannulation success with standard techniques is reported to be around 90%. Even in expert hands and despite all efforts, it can be challenging that needs an alternate intervention. Needle-knife fistulotomy (NKF) is recommended as the initial technique for pre-cutting because the rate of post-ERCP pancreatitis (PEP) is significantly low. Still, it's performed as a free-hand technique without using a guidewire which may cause complications such as perforation and bleeding. We recently described a novel technique; partial ampullary mucosal resection (PA-EMR) for difficult biliary cannulation which may overcome some of NKF's limitations. Our aim was to compare the efficacy and safety of PA-EMR vs NKF [1] [2] [3] [4].
Methods The detailed information can be seen at: ClinicalTrials.gov (ID: NCT05068739) ([Table 1]).
Results The characteristics of the patients and procedure related characterstics arepresented in Table-1.
Conclusions Our results imply that PA-EMR has a comparable efficacy and safety profile against NKF. Moreover, the rate of complications may be lower and cannulation success in the first session may be higher. Multicenter studies with larger cohorts are needed to verify these preliminary results.
Conflicts of interest
Authors do not have any conflict of interest to disclose.
- 1 Peng C., Nietert P.J., Cotton P.B.. et al. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network. BMC Gastroenterol 2013; 13: 147
- 2 Sriram PV, Rao GV, Nageshwar Reddy D.. The precut--when, where and how? A review. Endoscopy 2003; 35: 24-30
- 3 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-83
- 4 Tokmak S., Cetin M.F., Torun S.. Feasibility and safety of partial ampullary endoscopic mucosal resection: a novel technique for difficult biliary cannulation (with video). Surg Endosc 2022;
Publication History
Article published online:
14 April 2023
© 2023. European Society of Gastrointestinal Endoscopy. All rights reserved.
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- 1 Peng C., Nietert P.J., Cotton P.B.. et al. Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network. BMC Gastroenterol 2013; 13: 147
- 2 Sriram PV, Rao GV, Nageshwar Reddy D.. The precut--when, where and how? A review. Endoscopy 2003; 35: 24-30
- 3 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-83
- 4 Tokmak S., Cetin M.F., Torun S.. Feasibility and safety of partial ampullary endoscopic mucosal resection: a novel technique for difficult biliary cannulation (with video). Surg Endosc 2022;