Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Abstract

AIM:To compare the rates of success and complications of two different methods of access into the common bile duct (CBD). METHODS:Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi's syndrome. RESULTS:Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS). CONCLUSION:Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.

Papillary fistulotomy vs conventional cannulation for endoscopic biliary access: A prospective randomized trial

“…No bleeding was observed. The negligible incidence of bleeding is consistent with previous precut studies (0-3.4%)[ 2 , 17 , 26 , 28 , 35 ]. In regards to perforation (0-1.8%), our results are also quite acceptable[ 2 , 17 , 26 , 28 , 35 ].…”

“…Cannulation of the bile duct using PF was accomplished in all patients in Group II. Three previous studies with a similar design displayed 89.3%-96.5% success rates for fistulotomy[ 26 - 28 ]. In the control group (conventional technique), the corresponding values were 70.6% and 88%[ 26 - 28 ].…”

Transpapillary selective bile duct cannulation technique: Review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004

“…One hundred twenty‐four articles were judged not suitable for pooled analysis based on their abstracts. After vetting was complete, 69 articles were reviewed.…”

Fistulotomia papilar versus cateterização convencional para acesso biliar endoscópico: avaliação clínico-laboratorial

“…A distância do óstio papilar para a artéria nutridora é Em relação a perfuração são relatados na literatura incidência de 0% a 1,8% 5,12,65,[76][77][78] . Neste estudo, ocorreram duas perfurações (3,9%) no…”

“…A incidência de hemorragia foi semelhante a estudos prévios de pré-corte e variam de 0 a 3,4% 5,12,65,[76][77][78] .…”