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

Donnellan, Fergal; Enns, Robert; Kim, E.; Lam, Eric; Amar, Jack; Telford, Jennifer J.; Byrne, Michael F.

doi:10.1007/s10620-011-1982-6

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…The strategy of performing a second ERCP within a short time-frame when an NKF is unsuccessful in the first ERCP was highly effective and safe, as reported by Kim et al and Donnellan et al [22,23]. A 72% success rate in accessing the bile duct was achieved in the 25 rescheduled patients, with no complications.…”

Section: Discussionmentioning

confidence: 67%

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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Section: Discussionmentioning

confidence: 67%

Safety and efficacy of precut needle-knife fistulotomy

Lopes

Dinis-Ribeiro

Rolanda

2014

Scandinavian Journal of Gastroenterology

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“…The strategy of performing a second ERCP when an NKF is unsuccessful in the first ERCP was highly effective and safe, as previously reported. 17,18 The results suggest that the success rates for these 2 cannulation strategies are similar.…”

Section: Discussionmentioning

confidence: 79%

Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

Lopes

Dinis-Ribeiro

Rolanda

2014

Gastrointestinal Endoscopy

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“…A large proportion (60%) of our patients received PTD only after failed endoscopy. This reflects current practice, since most patients are referred to PTD providing centers with endoscopic stent in situ or after failed ERCP [ 30 , 31 ]. High pre-interventional cholangitis rates also indicate the supposed adverse event of previous endoscopic intention and raises the question whether ERCP or PTD is the first choice of treatment in obstructive jaundice.…”

Section: Discussionmentioning

confidence: 91%

Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

Kokas

Szíjártó²,

Farkas³

et al. 2021

PLoS ONE

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Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

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

Abstract: Repeat ERCP within a few days after failed use of a needle knife for biliary access is associated with acceptable success and acceptable incidence of complications, and therefore obviates the need for alternative approaches for biliary access for most patients.

Cited by 18 publications

References 14 publications

Safety and efficacy of precut needle-knife fistulotomy

Safety and efficacy of precut needle-knife fistulotomy

Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

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