title: Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors.
abstract: BACKGROUND
  Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors.
  
  
  METHODS
  Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP.
  
  
  RESULTS
  For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34-3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52-15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55-22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21- 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis.
  
  
  CONCLUSIONS
  Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.
authors: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
authors: Hirotoshi
authors: H
authors: Fukatsu
authors: Hirofumi
authors: H
authors: Kawamoto
authors: Hironari
authors: H
authors: Kato
authors: Ken
authors: K
authors: Hirao
authors: Naoko
authors: N
authors: Kurihara
authors: Takashi
authors: T
authors: Nakanishi
authors: Osamu
authors: O
authors: Mizuno
authors: Yuko
authors: Y
authors: Okamoto
authors: Tsuneyoshi
authors: T
authors: Ogawa
authors: Etsuji
authors: E
authors: Ishida
authors: Hiroyuki
authors: H
authors: Okada
authors: Kohsaku
authors: K
authors: Sakaguchi
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002779:Cholestasis / Q000209:etiology / Q000601:surgery*; D016001:Confidence Intervals; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000503:physiopathology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
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