Failed biliary access following needle knife fistulotomy: is repeat interval ERCP worthwhile?

Abstract

Follow-up ERCP after a short interval is worthwhile in patients for whom initial ERCP and fistulotomy is unsuccessful as biliary access is frequently obtained without further intervention and definitive management is facilitated in the majority of cases.

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

“…Patients in this series underwent needle knife fistulotomy during the initial ERCP and access was achieved in all cases via the same site by use of standard cannulation techniques without the need for further use of the needle knife. There were no complications after the repeat procedures [12]. Our study, with successful Fig.…”

“…A sufficient period should elapse to enable resolution of electrocautery-related papillary edema and tissue necrosis. In the study by Kevans et al [12] repeat ERCP was performed after an average of 6 days whereas in our study it was undertaken, on average, 7 days after the failed initial procedure.…”

Results of repeat endoscopic retrograde cholangiopancreatography after initial biliary cannulation failure following needle‐knife sphincterotomy

“…Recently, the results of repeated interval ERCP after failed biliary cannulation with NKS from one center indicated a two-thirds success rate in initially failed cases. 8 Here, we present success rates at one center for repeated ERCP after failed NKS and we discuss the factors associated with success of the repeated procedure.…”

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…84 A lower risk of PEP with fistulotomy should also be weighed against the possibility of lower initial success and final success if/when repeat ERCP is attempted. 85 Risk of NKS is quite low when pancreatic stenting is employed (see below).…”