Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones

Mavrogiannis, Christos; Liatsos, Christos; Romanos, Andreas; Petoumenos, Christos; Nakos, Antonios; Karvountzis, G.

doi:10.1053/ge.1999.v50.98593

Cited by 141 publications

(139 citation statements)

References 21 publications

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“…If selective cannulation was still unsuccessful, precut sphincterotomy was then attempted using a standard needle-knife with pure cutting current with or without prior placement of a pancreatic duct stent [4,15] . The precut method used was similar to the technique described by Mavrogiannis for the removal of CBD stones [16] . The PBS incision began between the 11:00 and 1:00 positions in the middle to upper part of the intraduodenal portion of the CBD.…”

Section: Methodsmentioning

confidence: 99%

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise

Robison

Varadarajulu²,

Wilcox³

2007

WJG

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AIM:To determine the rates of success and complications of precut biliary sphincterotomy (PBS) based on prior experience and to compare the complication rates between PBS and standard endoscopic sphincterotomy (ES). METHODS:A retrospective evaluation of prospectively collected non-randomized data at an academic tertiary referral center. The study included all patients in an eight-year period who underwent PBS and ES by a single endoscopist who had no formal training in PBS. The main outcome measures of the study were success and complications of PBS with a comparison to complications of ES. RESULTS:A total of 2939 endoscopic retrograde chola ngiopancreatographies (ERCPs) were performed during the study period, including 818 (28%) ES and 150 (5%) PBS procedures. Selective biliary cannulation via PBS was successful at the first attempt in 75% of the patients. Cannulation was achieved in an additional 13% of the patients at a subsequent attempt (total 87%). Complication rate from PBS was 45% higher than ES, but did not differ significantly [7% (10/50) vs 5% (38/818), P = 0.29]. None of the complications from PBS was severe. A significant trend towards increasing success existed with regard to the endoscopist's first attempt at precut (P = 0.0393, Cochran-Armitage exact test for trend, Z = -1.7588). CONCLUSION:Despite the lack of specific training in this technique, PBS was performed with a high success rate and a complication rate similar to or less than reports from other experienced centers. These results suggest that endoscopic experience and perhaps innate endoscopic skill may play an important role in the outcome of this procedure.

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Section: Methodsmentioning

confidence: 99%

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise

Robison

Varadarajulu²,

Wilcox³

2007

WJG

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“…One study [18] reported no cases of pancreatitis when the CBD was cannulated from the suprapapillary portion (i.e., at a defined distance from the Oddi sphincter). A randomized comparative study of "fistulotomy" above the orifice vs conventional needle knifing at the orifice found a significantly lower rate of pancreatits in the fistulotomy subset (0% vs 8%) of 153 patients with suspected choledocholithiasis [19] . In our study, group F showed only one case of mild pancreatitis; in group S there were only mild cases of pancreatitis (5.8% of patients).…”

Section: Peer Reviewmentioning

confidence: 99%

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

Ayoubi¹,

Sansoè²,

Leone³

et al. 2012

WJGE

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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.

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“…15,16 In this method, the cutting starts from the suprapapillary lesion (papillary roof) to avoid the orifice, whereas the standard needle knife method cuts the suprapapillary lesion, including the orifi ce. Post-ERCP pancreatitis may be prevented by avoiding papillary edema.…”

Section: Discussionmentioning

confidence: 99%

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

Matsuda

Yoshida

2008

Clinical Medicine. Gastroenterology

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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.

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Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones

Cited by 141 publications

References 21 publications

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise

Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise

Comparison between needle-knife fistulotomy and standard cannulation in ERCP

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

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