Predictive factors of needle-knife pre-cut papillotomy failure in patients with difficult biliary cannulation

Abstract

Predictors of needle-knife pre-cut papillotomy (NKP) failure for patients with difficult biliary cannulation has not been reported. Between 2004 and 2016, 390 patients with difficult biliary cannulation undergoing NKP were included in this single-center study. Following NKP, deep biliary cannulation failed in 95 patients (24.4%, NKP-failure group) and succeeded in 295 patients (75.6%, NKP-success group). Patient and technique factors were used to identify the predictors of initial NKP failure. Compared with the NKP-success group, periampullary diverticulum (28.4% vs. 18%, p = 0.028), surgically altered anatomy (13.7% vs. 7.1%, p = 0.049), number of cases performed by less experienced endoscopists, and bleeding during NKP (38.9% vs. 3.4%, p < 0.001), were significantly more frequent in the NKP-failure group. On multivariate analysis, surgically altered anatomy (OR 2.374, p = 0.045), endoscopists’ experience (OR 3.593, p = 0.001), and bleeding during NKP (OR 21.18, p < 0.001) were significantly associated with initial failure of NKP. In conclusion, NKP is a highly technique-sensitive procedure, as endoscopists’ experience, bleeding during NKP, and surgically altered anatomy were predictors of initial NKP failure.

Impact of papillary morphology and diverticular type on needle-knife precut sphincterotomy in patients with periampullary diverticulum with difficult biliary cannulation

“…However, needle-knife precut sphincterotomy (NKPS), which includes needle-knife papillotomy (NKP) and needle-knife stulotomy (NFK), does not consistently achieve SBC 10,11 . Our previous study indicated a signi cant association between PAD and NKP failure in univariate analysis, although not in multivariate analysis 12 . Given the variability of PAD among patients, the type of PAD may in uence the success of NKPS in PAD patients.…”

“…The details of ERCP and NKPS procedures were described in our previous study 12 . In short, the standard cannulation method using a cannula or sphincterotomy, and sometimes the double guidewire method by some endoscopists after the failure of the standard cannulation methods, were considered conventional cannulation methods in this study.…”

Does early application of needle-knife sphincterotomy (NKS) in patients with difficult biliary cannulation increase the risk of postERCP pancreatitis? A single centre study

“…Difficult biliary cannulation was defined as more than five attempts at papillary cannulation, more than five minutes spent to cannulate after papilla was clearly visualized or more than one inadvertent PD cannulation. 9 Technical success was defined as free and deep instrumentation of the biliary tree. 8 Total time of the procedure was defined as the time from initial intubation to the procedure termination 1 .…”

Does patient’s position count during Endoscopic Retrograde Cholangio-pancreatography? Left lateral decubitus versus prone position

“…Difficult biliary cannulation was defined as more than five attempts at papillary cannulation, more than five minutes spent to cannulate after papilla was clearly visualized or more than one inadvertent PD cannulation. 8 …”

“…Difficult biliary cannulation was defined as more than five attempts at papillary cannulation, more than five minutes spent to cannulate after papilla was clearly visualized or more than one inadvertent PD cannulation. 8 Technical success was defined as free and deep instrumentation of the biliary tree. 7 Total time of the procedure was defined as the time from initial intubation to the procedure termination.…”