title: Saline injection needle-knife sphincterotomy: a preliminary report.
abstract: OBJECTIVE
  Needle-knife sphincterotomy is an established technique in the management of some patients with biliary tract obstruction. However, the technique can be technically difficult in patients with very small papillae, specially when associated with distorted ampullary and duodenal anatomy. We present here a technique that may enhance successful needle-knife sphincterotomy in this situation.
  
  
  METHODS
  Eight patients with biliary tract obstruction who had small papillae and distorted ampullary or duodenal anatomy were evaluated. All patients had undergone one or more unsuccessful cannulations prior to referral. All eight patients underwent saline injection of their papillae, creating a bulging papilla, prior to needle-knife sphincterotomy.
  
  
  RESULTS
  Seven of the eight patients had successful needle-knife sphincterotomy following saline injection, and endoscopic therapy during the first attempt. In one patient, the procedure was successful at a second attempt 48 hours later. There were no instances of significant complications.
  
  
  CONCLUSIONS
  Saline injection into the papilla prior to needle-knife sphincterotomy may improve success rates in patients with unusually small papillae and distorted ampullary or duodenal anatomy. However, at present this technique should only be attempted by experienced endoscopists. Further studies with larger numbers of patients are required before the safety of this technique can be fully evaluated.
authors.affiliation: Section of Digestive and Liver Diseases, University of Illinois at Chicago, USA.
authors.forename: K P
authors.initials: KP
authors.lastname: Etzkorn
authors.forename: R P
authors.initials: RP
authors.lastname: Venu
authors.forename: R D
authors.initials: RD
authors.lastname: Brown
authors.forename: D E
authors.initials: DE
authors.lastname: McGuire
authors.forename: A
authors.initials: A
authors.lastname: Abu-Hammour
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D002277:Carcinoma / Q000150:complications; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000601:surgery; D003251:Constriction, Pathologic / Q000150:complications; D004384:Duodenoscopy; D042882:Gallstones / Q000150:complications; D006801:Humans; D015552:Injections, Intralesional / Q000295:instrumentation; D009101:Multiple Myeloma / Q000150:complications; D009339:Needles; D010190:Pancreatic Neoplasms / Q000150:complications; D011446:Prospective Studies; D012086:Reoperation; D012449:Safety; D012965:Sodium Chloride / Q000008:administration & dosage; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014743:Videotape Recording
chemical_list: D012965:Sodium Chloride