Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones.
BACKGROUND
The aim of this prospective study was to evaluate and compare the efficacy and safety of two different precutting techniques in the treatment of 103 consecutive patients with choledocholithiasis.


METHODS
The patients were randomized into two groups. The first group included 74 patients who underwent needle-knife fistulotomy avoiding the papillary orifice followed by standard papillotomy. Fifty-two of these patients had a final diagnosis of choledocholithiasis. The second group included 79 patients who underwent needle-knife precut papillotomy starting from the papillary orifice followed by standard papillotomy. Fifty-one of these patients had a final diagnosis of choledocholithiasis.


RESULTS
Precutting was successful in 90.54% of patients in the needle-knife fistulotomy group and 88.6% of patients in the needle-knife precut papillotomy group. Stone extraction without mechanical lithotripsy was achieved in 40 of 48 (83.33%) patients in the needle-knife fistulotomy group and 45 of 46 (97.82%) patients in the needle-knife precut papillotomy group (p < 0.05). For the other patients, stone extraction was achieved with the aid of a mechanical lithotriptor. Complications were as follows for the needle-knife fistulotomy and needle-knife precut papillotomy groups, respectively: bleeding, 6.75% and 5.06%; perforation, 2.7% and 2. 53%; cholangitis, 1.35% and 0; pancreatitis, 0 and 7.59% (p < 0.05); hyperamylasemia, 2.7% and 17.72% (p < 0.01); and death, 0 and 1.26%.


CONCLUSIONS
Both methods are effective in the management of choledocholithiasis. When needle-knife fistulotomy is performed, however, lithotripsy is needed more often. Needle-knife fistulotomy is safer than needle-knife precut papillotomy with respect to pancreatic complications.
Mavrogiannis
C
C
Gastroenterology Unit, Hippokration Hospital of Athens, Greece.
Liatsos
C
C
Romanos
A
A
Petoumenos
C
C
Nakos
A
A
Karvountzis
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation* / Q000379:methods*; D013525:Surgical Instruments; D016896:Treatment Outcome