Suprapapillary needleknife fistulotomy: a safe and effective method for accessing the biliary system

Donnellan, Fergal; Zeb, Faisal; Courtney, Garry; Aftab, AR

doi:10.1007/s00464-010-0881-9

Cited by 22 publications

(19 citation statements)

References 14 publications

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“…Requirement for PF was somewhat higher than in previous reports (3.8-19.2%) [7], at 23.1%, because all of the procedures were performed by a junior endoscopist after training. Overall, previously reported successful cannulation rates were 90% and complication rates, considering pancreatitis, bleeding, perforation, and cholangitis were 5-19% in precut fistulotomy [1,2,19,[32][33][34]. In our present study, the overall complications and post-ERCP pancreatitis rates were similar to those reported previously, at 10.7 and 5.7%, respectively, and the overall success rates were also similar, at 93.7%.…”

Section: Discussionsupporting

confidence: 92%

Precut Fistulotomy for Difficult Biliary Cannulation: Is It a Risky Preference in Relation to the Experience of an Endoscopist?

et al. 2010

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Section: Discussionsupporting

confidence: 92%

Precut Fistulotomy for Difficult Biliary Cannulation: Is It a Risky Preference in Relation to the Experience of an Endoscopist?

et al. 2010

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“…With 204 patients, this study includes one of the largest series of NKF approach to date for a single center [18,19]. In our series, precut NKF was highly useful in achieving a deep biliary cannulation in the first ERCP (96%).…”

Section: Discussionmentioning

confidence: 86%

Safety and efficacy of precut needle-knife fistulotomy

Lopes

Dinis-Ribeiro

Rolanda

2014

Scandinavian Journal of Gastroenterology

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OBJECTIVE. Although precut is considered an useful alternative when standard methods of biliary access have failed, there is some controversy about it's safety. The study aim was to evaluate the effectiveness of needle-knife fistulotomy (NKF) after a difficult biliary cannulation and whether common bile duct (CBD) diameter influenced complications. MATERIAL AND METHODS. Between November 2006 and December 2010, a total of 1087 consecutive patients with naive papilla were submitted to endoscopic retrograde cholangiopancreatography (ERCP) for biliary access, in an affiliated university hospital. If the biliary cannulation was unsuccessful after 12-15 min, a NKF was performed. The main outcomes were biliary cannulation rate, NKF success and post-ERCP complications. RESULTS. Biliary cannulation by standard methods was successful in 883 patients (81%). In the remaining 204 patients, NKF was performed and allowed CBD access in 166 (81%), leading to a 96% cannulation rate. A second ERCP was performed in 25 patients, with an NKF success of 90% and an overall biliary cannulation rate of 98%. The post-ERCP complication rate was 7.9% (n = 16) with a 6.4% pancreatitis rate and no deaths. The complication for patients with a CBD ≤ to 4 mm was 13.9% compared with 4.5% in the remaining patients (OR = 3.39, p = 0.024). CONCLUSIONS. NKF is a safe and highly useful method of accessing the CBD in the setting of a difficult biliary cannulation. Despite its safety profile, extra caution is needed when applying NKF to patients with thin bile ducts.

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“…It has been shown to be effective, with success of subsequent cannulation up to 90% in experienced hands [6,7]. When cannulation is unsuccessful a number of different approaches are available to gain access to the biliary system.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Repeat ERCP After Initial Failed Use of a Needle Knife for Biliary Access

et al. 2011

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Suprapapillary needleknife fistulotomy: a safe and effective method for accessing the biliary system

Abstract: Suprapapillary needleknife fistulotomy is an effective method for accessing the biliary system after failed standard cannulation. Despite a higher rate of mild bleeding, fistulotomy was not associated with an increased risk of serious complications.

Cited by 22 publications

References 14 publications

Precut Fistulotomy for Difficult Biliary Cannulation: Is It a Risky Preference in Relation to the Experience of an Endoscopist?

Precut Fistulotomy for Difficult Biliary Cannulation: Is It a Risky Preference in Relation to the Experience of an Endoscopist?

Safety and efficacy of precut needle-knife fistulotomy

Outcome of Repeat ERCP After Initial Failed Use of a Needle Knife for Biliary Access

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