Needle knife papillotomy for endoscopic sphincterotomy and cholangiography

Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

“…First, the proportion of ERCP patients receiving NKPP in our study was higher than in previous reports [4,6,9], possibly due to the early introduction of NKPP, within at least 20 min after the start of biliary cannulation. In addition, the higher proportion also may have been related to the large number of patients who underwent a hepatectomy or subtotal gastrectomy.…”

“…Failure to gain access into the bile duct is a common problem that can result from operator inexperience or anatomic reasons such as prior surgery [1,2]. When selective biliary cannulation is difficult, alternatives to the standard technique, such as precut papillotomy including fistulotomy or a combined percutaneous-endoscopic approach is required [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. However, these techniques often are associated with an increased potential risk for complications including bleeding, perforation, and pancreatitis.…”

Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation

“…The use of a precut papillotomy to facilitate biliary cannulation remains controversial and the indications and timing for the precut technique vary. The precut rate varies from zero to as many as 38% of all biliary cannulation attempts [14,20]. Although the precut papillotomy may improve the cannulation success rate, prospective studies have suggested that this procedure is an independent risk factor for a post-ERCP complication [2,9].…”

Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy

“…A variety of accessories and techniques for achieving the biliary cannulation has been described [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Although NKPP has been a useful alternative for achieving the selective biliary cannulation, the number of NKPP procedures required to achieve technical proficiency remains controversial.…”

“…Failure to gain access to the bile duct is a common problem that can occur due to operator inexperience or for anatomic reasons such as prior surgery [1][2][3]. When selective biliary cannulation is difficult by the standard technique, alternative procedures such as precut papillotomy, including fistulotomy or a combined percutaneous endoscopic approach, are required [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. However, these techniques often are associated with an increased potential risk for complications including bleeding, pancreatitis, and perforation.…”