Needle-knife papillotomy: a safe and effective technique in experienced hands.
OBJECTIVE
Results from studies evaluating needle-knife papillotomy are conflicting. The aim of this retrospective study was to assess the safety and efficacy of needle-knife papillotomy as a precut procedure to achieve biliary access during ERCP.


METHODS
During a period of seven years, ERCP was performed 938 times. During this time, needle-knife papillotomy was carried out in 68 patients, with complete follow-up obtained in all patients. The follow-up concentrated on the safety and efficacy of the procedure and short-term complications.


RESULTS
Cannulation of the common bile duct was successful immediately after needle-knife papillotomy in 44 patients (66%), during a second ERCP in 18 patients (26%), and in a third ERCP in 2 patients (3%) achieving a total cannulation rate of 94%. There were no needle-knife papillotomy related deaths. Complications included bleeding in 5 patients (7%), and pancreatitis in 3 patients (4%). All complications were managed conservatively.


CONCLUSIONS
Our experience indicates that needle-knife papillotomy is a versatile, effective and safe technique of gaining biliary access in patients in whom deep cannulation proves impossible and biliary access is considered essential.
Katsinelos
P
P
Department of Endoscopy, Central Hospital, Thessaloniki, Greece.
Mimidis
K
K
Paroutoglou
G
G
Christodoulou
K
K
Pilpilidis
I
I
Katsiba
D
D
Kalomenopoulou
M
M
Papagiannis
A
A
Tsolkas
P
P
Kapitsinis
I
I
Xiarchos
P
P
Beltsis
A
A
Eugenidis
N
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000473:pathology* / Q000601:surgery*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods*