Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

Liang, Kai-Shun; Chen, Chieh‐Chang; Liao, Wei‐Chih; Kuo, Ying-Shiung; Tseng, Liang‐Wei; He, Wen-Tsung; Wang, Hsiu‐Po

doi:10.1186/s12876-020-01323-x

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…We believe that the NKF method is safe in terms of perforation risk when performed by separating the structures above the bile duct layer by layer up to the sphincter muscle layer and by piercing the sphincter muscle by sight. 34 This safe profile is also supported by the absence of perforation with NKF cannulation in the 47-patient study of Liang et al 35 and the 34-patient study of Park et al 36 Moreover, Park et al 26 did not observe any perforation with NKF employment in 33 patients with perivaterian diverticulum, as in the 4 patients in the presented study. Furthermore, Lopes et al 9 observed a perforation in 1 of 72 patients with a common bile duct diameter ≤ 4 mm who underwent NKF cannulation.…”

Section: Discussionsupporting

confidence: 78%

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Başpinar¹,

Ödemiş²,

Erdoǧan³

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an important therapeutic tool for many biliary diseases. Selective biliary cannulation is the first step of the treatment process. Needle knife fistulotomy (NKF) and conventional precut sphincterotomy (CPS) are widely used in difficult biliary cannulation. However, there are different results in their effectiveness and safety. This study aimed to compare both methods regarding cannulation success and adverse event profile.Materials and Methods: All eligible consecutive patients with naive papillae who underwent biliary ERCP by a single experienced endoscopist over a 3-year period were included retrospectively. The standard cannulation method with a guidewire-loaded sphincterotome was initially used for biliary cannulation in all patients. Cannulation was accepted as difficult in the case of failure of standard cannulation within 5 minutes or despite 5 attempts or insertion of the guidewire to the pancreatic duct 5 times. Three modalities in patients with difficult biliary cannulation were employed according to the structure and configuration of the papillae in addition to unintentional pancreatic cannulation: (1) NKF, (2) CPS, (3) Double guidewire technique or guidewire orientation/ precut following pancreatic stenting. Latter was excluded to enable direct comparison between NKF and CPS groups.Results: A total of 644 patients were recruited. Analyses were performed with 541 patients after the exclusion of 103 patients. Mean (SD) age was 60.4 (18.2) years, and 257 (47.5%) patients were male. While standard cannulation was successful in 366 (67.6%), difficult biliary cannulation was observed in 175 (32.4%) patients. NKF was performed in 101 (57.7%) patients, and cannulation success was 100% in the first ERCP session. In contrast, CPS was performed in 74 (42.3%) patients with a lower cannulation success rate (79.7%) than NKF (P < 0.001). Post-ERCP pancreatitis rate was higher in CPS (9.5%) than NKF group (3.0%, P = 0.063). Bleeding and cholangitis were similar in both groups.Conclusions: In patients with difficult biliary cannulation with appropriate papillary structure and configuration, NKF should be used as the first choice in experienced hands because of high biliary cannulation success and low Post-ERCP pancreatitis risk.

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Section: Discussionsupporting

confidence: 78%

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Başpinar¹,

Ödemiş²,

Erdoǧan³

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…The successful cannulation rate for TPBS with additional NKF was up to 83.9 %. The adverse events rates were not significantly different [7].…”

mentioning

confidence: 78%

Transpancreatic biliary sphincterotomy for difficult biliary cannulation: can it be better than other methods?

Wang

2021

Endoscopy

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Selective biliary cannulation is the critical step when endoscopic retrograde cholangiopancreatography (ERCP) is used to manage pancreaticobiliary diseases. However, difficult cannulation and failure of initial biliary cannulation can occur in 10 %-20 % of patients with a native major papilla [1]. Difficult biliary cannulation increases the risk of post-ERCP adverse events, such as post-ERCP pancreatitis (PEP), post-ERCP bleeding, and perforation.

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“…Although some previous studies have compared NKP and TPS, the conclusions were inconsistent. However, several studies focused on this topic have been published recently [15, 16]. The aim of this meta-analysis was to compare NKP and TPS in difficult cannulation during ERCP.…”

Section: Introductionmentioning

confidence: 99%

Comparison between Transpancreatic Sphincterotomy and Needle-Knife Precut in Difficult Cannulation of Endoscopic Retrograde Cholangiopancreatography: An Up-To-Date Meta-Analysis and Systematic Review

Lyu

Wang

et al. 2022

Dig Dis

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Background Selective cannulation, which is essential for endoscopic retrograde cholangiopancreatography (ERCP), may be difficult. The aim of this study was to compare transpancreatic sphincterotomy (TPS) and needle-knife precut (NKP) in difficult cannulation during ERCP. Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for relevant studies from January 1990 to April 2022. A meta-analysis focusing on cannulation success and post-ERCP complications was performed by Review Manager. Results Seventeen eligible studies involving 2340 patients were included. Our results showed that the TPS group had a higher cannulation success rate (odds ratio (OR) 0.48, 95% confidence interval (CI) 0.27–0.87, p = 0.02) and less bleeding (OR 1.94, 95% CI 1.09–3.47, p = 0.03) compared with the NKP group. There was no significant difference between NKP and TPS in the rates of post-ERCP pancreatitis (OR 0.83, 95% CI 0.59–1.18, p = 0.30), perforation (OR 2.04, 95% CI 0.69–6.03, p = 0.20), and adverse events (OR 1.29, 95% CI 0.94–1.77, p = 0.12). Conclusion TPS appears to be associated with a higher cannulation success rate and less bleeding than those with NKP, with equal post-ERCP pancreatitis, perforation, and adverse events rates between TPS and NKP. Further large-scale trials are warranted to support our findings.

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Comparison between transpancreatic sphincterotomy and needle-knife fistulotomy in difficulty biliary access, a retrospective study in Taiwan

Cited by 6 publications

References 22 publications

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Suprapapillary Needle Knife Fistulotomy Versus Conventional Precut Sphincterotomy in Difficult Biliary Cannulation: A Retrospective Comparative Study

Transpancreatic biliary sphincterotomy for difficult biliary cannulation: can it be better than other methods?

Comparison between Transpancreatic Sphincterotomy and Needle-Knife Precut in Difficult Cannulation of Endoscopic Retrograde Cholangiopancreatography: An Up-To-Date Meta-Analysis and Systematic Review

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