Needle-Knife Fistulotomy as a Rescue Access of the Common Bile Duct in Cirrhotic Patients: Feasibility and Outcome

Abstract

transpapillary wireguided cannulation with standard sphincterotomy. Cannulation was evaluated for duration, number of trials, use of aiding instruments and success rate. Results: Success rate of CBD cannulation and fair dye drainage was reported in 93.3% and 73.3%, 86.7% and 80%, 85% and 70%, 85% and 80% of patients in groups A,B, C and D respectively, with no statistically significant difference among the four groups. The only complication reported in group A was bleeding (three patients). No statistically significant difference among the four groups regarding post-procedural complications was noticed. Conclusion: Suprapapillary needleknife fistulotomy can be used in cirrhotic patients when standard biliary cannulation proves to be difficult, it is associated with a high success rate and a low complication risk.

ERCP among Cirrhotics: What are the differences?

“…In Egypt, our experience in managing cirrhotic and HCV infected patients have been improved over the last decades with the introduction of interferon based and direct antiviral therapies and this yield an improved longevity among those patients [16][17][18][19]. Consequently, it is a daily medical practice to see cirrhotic patients in the ERCP theaters [17] face to face and as an endoscopist you have to tailor the treatment [12,18,20].…”

“…Simply because cirrhosis is associated with impaired hepatic detoxification function exposing patients to complications of sedatives and anesthetic drugs, also cirrhotic patients tolerate stress badly, as well as impaired immunity predispose them to higher infectious complications particularly with increasing Child class [12,18,24-28]. On the other hand, bleeding is the expected adverse event to be high among cirrhotics due to both coagulopathy and low platelet count [18]. A recent meta-analysis showed that patients with cirrhosis had higher overall rates of complications compared to noncirrhosis [23].…”

“…We give our patients parenteral vit K and IV fresh frozen plasma before ERCP if the PT exceeds 16. In one study during the procedure the bleeding (6/11 patients) was mild and stopped either by cautery or after diluted adrenaline flushing, while delayed bleeding (5/11patients, all presented with melena) was treated conservatively and with blood transfusion and plasma, neither surgery nor therapeutic angiography were needed in all cases [18].…”

ERCP : Is it Really Safe in Cirrhosis?

“…Patients with liver cirrhosis are at increased risk for complications after surgery [2] and probably also after the major endoscopic techniques including the ERCP. That is why the paper published by El-Naggar et al, 2013 in the Afro-Egyptian Journal of Infectious and Endemic Diseases [3] seems interesting; the authors performed several invasive procedures in patients with Child A and B liver cirrhosis and the outcomes were unexpectedly excellent.…”