Utility of needle-knife fistulotomy as an initial method of biliary cannulation to prevent post-ERCP pancreatitis in a highly selected at-risk group: a single-arm prospective feasibility study

• Published in: Gastrointestinal endoscopy Vol. 84; no. 5; pp. 808 - 813
• Main Authors: Jin, Young-Joo, M.D., PhD, Jeong, Seok, M.D., PhD, Lee, Don Haeng, M.D., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Adult; Aged; Aged, 80 and over; Ampulla of Vater - surgery; Catheterization - adverse effects; Catheterization - methods; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Common Bile Duct; Feasibility Studies; Female; Gallstones - surgery; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Operative Time; Pancreatitis - etiology; Pancreatitis - prevention & control; Prospective Studies; Risk Factors; Sphincterotomy, Endoscopic - adverse effects; Sphincterotomy, Endoscopic - methods; RCT; gallbladder; CBD; AoV; ampulla of vater; periampullary diverticulum; endoscopic ultrasonography; common bile duct; laparoscopic cholecystectomy; Needle knife fistulotomy; GB; post-ERCP pancreatitis; computed tomography; Endoscopic retrograde cholangiopancreatography; EUS; Pancreatitis; NKF; needle-knife fistulotomy; randomized controlled trial; CT; PAD; LC; ERCP; PEP; Common bile duct stone; NSAIDs; SOD
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2016.04.011

Abstract Background /Aim: We intended to assess the feasibility of needle-knife fistulotomy (NKF) as an initial procedure for biliary access in common bile duct (CBD) stone patients who were at increased risk for post-ERCP pancreatitis (PEP). Method Fifty-five patients who underwent ERCP with NKF for CBD stone at our institution between July, 2013, and May, 2015, were prospectively enrolled in this study. They had one or more of the following risk factors for PEP: young age (<60 years), female, or normal CBD diameter (≤9 mm). The procedure was performed by an expert biliary endoscopist (S.J.). Success rate of biliary cannulation and CBD stone removal, and the incidence rate of adverse events were assessed. Results Seventeen patients had one risk factor for PEP, 27 had 2, and 11 had 3. Median procedure times of NKF and CBD stone removal after NKF were 2.1 minutes (range, 0.2-8.7) and 6.5 minutes (range, 1.1-28.3), respectively. Success rates of CBD cannulation and stone removal using NKF were 96.3% (53/55) and 92.7% (51/55), respectively. None of the patients experienced PEP. Retroperitoneal duodenal perforation occurred in one patient (1.8%), but it was successfully treated by conservative management. Conclusion NKF might be feasible as an initial procedure for biliary access in CBD stone patients with high risk for PEP if the procedure is performed by an expert biliary endoscopist (Clinical trial registry number: KCT0001698).