title: Needle-knife sphincterotomy in a tertiary referral center: efficacy and complications.
abstract: BACKGROUND
  The use of needle-knife sphincterotomy as a method of precut sphincterotomy has been criticized as potentially unsafe. Despite this, a number of tertiary referral centers have reported their successful use of this technique to increase the rate of common bile duct cannulation.
  
  
  METHODS
  We assessed the safety and efficacy of needle-knife sphincterotomy in 72 consecutive patients in whom attempts at standard common bile duct cannulation were unsuccessful. Bile duct diameters were correlated to the complication rate.
  
  
  RESULTS
  Cannulation of the common bile duct was successful immediately after needle-knife sphincterotomy in 50 patients (67%), and was successful in 17 of the 20 patients who underwent repeat ERCP, for a total cannulation rate of 93%. Eight patients (11%) experienced complications. Retroduodenal perforation during guide wire cannulation attempts and bleeding occurred as frequently as pancreatitis. Small duct size was a risk factor for complications. There was no procedure-related mortality, and all complications were managed medically.
  
  
  CONCLUSIONS
  Needle-knife sphincterotomy was effective in facilitating cannulation in patients in whom standard cannulation attempts failed. Limiting guide wire manipulation of the fresh sphincterotomy site and excluding patients with small duct size may further reduce the complication rate.
authors.affiliation: Beth Israel Medical Center, New York, New York, USA.
authors.forename: F E
authors.initials: FE
authors.lastname: Kasmin
authors.forename: D
authors.initials: D
authors.lastname: Cohen
authors.forename: S
authors.initials: S
authors.lastname: Batra
authors.forename: S A
authors.initials: SA
authors.lastname: Cohen
authors.forename: J H
authors.initials: JH
authors.lastname: Siegel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002404:Catheterization; D003135:Common Bile Duct; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies