title: Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography.
abstract: BACKGROUND
  Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10% of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or fistulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups.
  
  
  RESULTS
  A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with difficult biliary cannulation, 43 patients underwent needle-knife cut: the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques: the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Significant differences were observed in cannulation success rate and cannulation time but in complication rate between the two groups.
  
  
  CONCLUSIONS
  The early application of the needle-knife in difficult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.
authors.affiliation: Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. chow@zshospital.net
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Gao
authors.forename: Guo-Jie
authors.initials: GJ
authors.lastname: He
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.forename: Xin-Yu
authors.initials: XY
authors.lastname: Qin
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013997:Time Factors