title: [Needle-knife sphincterotomy for biliary access: a prospective study].
abstract: OBJECTIVE
  Needle-knife sphincterotomy (NKS) is used to achieve biliary access when routine cannulation methods have been unsuccessful. The aim of this study was to analyze the results of NNS in patients with an inaccessible common bile duct (difficult cannulation) using standard techniques in endoscopic retrograde cholangiopancreatography and the factors associated with the success of this procedure and complications.
  
  
  METHODS
  We performed a prospective study of 72 patients who underwent NKS performed by the same endoscopist (J.E.) because of difficult cannulation of the common bile duct between January 1998 and December 2004. The results were analyzed in terms of successful biliary access, whether this was achieved in one or more sessions, its possible association with the underlying disease, and the incidence and severity of complications.
  
  
  RESULTS
  Seventy-two NKS were performed from a total of 1062 sphincterotomies (6.7%). A total of 77.7% of the patients underwent prior implantation of a pancreatic prosthesis (NKS-PP). The final diagnosis was: choledocholithiasis (31.9%), cancer of the pancreas (16.6%), cholangiocarcinoma (13.8%), benign stenosis (8.3%), dysfunction of the sphincter of Oddi (6.9%), normal (6.9%), and miscellaneous (13.8%). Cannulation was successful in 87.5% (63/72), and was achieved in the first session in 73% (46/63). Biliary access was achieved in 72.7% of patients (16/22) with biliopancreatic neoplasms versus 94% (47/50) of those with other diagnoses (p = 0.03). Eleven patients (15.2%) presented 12 complications (16.6%) (6 pancreatitis, 4 cholangitis, 1 papillary hemorrhage, and 1 portal vein filling). The use of a pancreatic prosthesis was related to a higher success rate and significantly fewer complications (p = 0.03).
  
  
  CONCLUSIONS
  NKS-PP can be a safe procedure in patients with difficult cannulation of the common bile duct. The presence of biliopancreatic neoplasm is a risk factor for failure to achieve biliary access compared with other diagnoses. The complication rate was similar to that found in other studies. No cases of severe pancreatitis or perforations were found.
authors.affiliation: Servicio de Aparato Digestivo, Hospital de León, León, España. jespinel@telefonica.net
authors.forename: J
authors.initials: J
authors.lastname: Espinel Diez
authors.forename: S
authors.initials: S
authors.lastname: Vivas Alegre
authors.forename: F
authors.initials: F
authors.lastname: Muñoz Núñez
authors.forename: A
authors.initials: A
authors.lastname: Domínguez Carbajo
authors.forename: R
authors.initials: R
authors.lastname: Villanueva Pavón
authors.forename: F
authors.initials: F
authors.lastname: Jorquera Plaza
authors.forename: J L
authors.initials: JL
authors.lastname: Olcoz Goñi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000293:injuries; D018281:Cholangiocarcinoma / Q000175:diagnosis; D002761:Cholangitis / Q000209:etiology; D042883:Choledocholithiasis / Q000175:diagnosis; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis; D003251:Constriction, Pathologic; D019723:Endoscopes; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D009803:Sphincter of Oddi / Q000473:pathology; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation*; D015607:Stents