Endoscopic Needle Knife Precut Papillotomy for Inaccessible Bile Duct following Failed Pancreatic Duct Access

Abstract

Aims: To evaluate the safety, effectiveness, success rate and complications of needle knife precut papillotomy for inaccessible bile duct after failed pancreatic ducts access.Methods: Selective common bile duct cannulation was required for 582 patients from November 2004 to May 2008. Precut sphincterotomy was performed in 28 patients (16 male, 12 female; mean age 71). When standard bile duct cannulation was unsuccessful after more than 20 minutes, the bile duct was considered inaccessible. Group A consisted of patients where pancreatic duct access was possible and transpancreatic papillary septotomy was performed (20 patients). If pancreatic duct cannulation also failed, needle knife precut method was performed and these patients belonged to group B (8 patients). The success and complication rates of the two groups were compared using the Chi-square test. Results:The success rates were 85% and 87.5% respectively. Of the 28 patients in group A, 6 had mild to moderate pancreatitis and one patient had mild bleeding. The complication rates were 35% and 0% respectively and the differences were not signifi cant. Conclusion:Needle knife precut papillotomy is useful and acceptable in patients after failed pancreatic duct access.

Transpancreatic Precut Sphincterotomy for Biliary Access: The Relation of Sphincterotomy Size to Immediate Success Rate of Biliary Cannulation

“…The incidence of post-TPS bleeding varies from 3.7 to 5% [ 7 , 16 ], our post-TPS bleeding was 15% which was a little higher and may be due to a small number of cases. Massive post-TPS bleeding was not reported in the literature.…”

“…The incidence of pancreatitis without prophylactic stenting after TPS ranged from 5.5 to 21% [ 4 , 7 , 13 ] and reduced to 3.5% if prophylactic pancreatic stenting was performed [ 5 ]. We had 3 cases (15%) of mild pancreatitis, but all of them recovered in 2 days.…”

“…The definitions were as follows: (1) inaccessible bile duct was defined as failure after 20 minutes of CBD cannulation [ 7 , 8 ], (2) complications of pancreatitis and bleeding were defined according to the criteria used by Cotton et al [ 9 ], and (3) large incision sphincterotomy was defined as incision up to superior margin of the bulging papilla [ 4 ].…”

The Safety and Efficacy of an Unflanged 4F Pancreatic Stent in Transpancreatic Precut Sphincterotomy for Patients with Difficult Biliary Cannulation: A Prospective Cohort Study

“…A meta-analysis has shown that the incidence of PEP in patients who underwent precut sphincterotomy was 5.28%, compared with 3.10% ( p < 0.001) in patients who did not [ 24 , 36 ]. Several studies have reported that the incidence of PEP was 5.5–21% [ 55 , 56 , 57 ] in TPS alone and 3.5–4.1% [ 50 , 58 , 59 , 60 ] in prophylactic PD stent placement after TPS. Moreover, the most recent studies have demonstrated that prophylactic PD stenting reduced the incidence of PEP [ 28 , 60 , 61 , 62 , 63 , 64 ].…”