Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy.
BACKGROUND
Although needle-knife precut papillotomy (NKPP) is considered a useful alternative for achieving selective biliary cannulation, controversy remains regarding the technical proficiency needed to perform the procedure and its safety. This study evaluated whether procedural experience with NKPP predicted either successful cannulation or the development of complications.


METHODS
This study retrospectively investigated 104 patients, out of 589 consecutive patients with native papillary, who underwent NKPP performed by a single endoscopist between October 2002 and July 2006. To demonstrate changes in NKPP, the 104 patients were divided chronologically into two groups according to periods: period A (October 2002 to September 2004) and period B (October 2004 to July 2006).


RESULTS
Of the 104 consecutive patients who underwent NKPP, 41 (41/267, 15%) were treated in period A and 63 (63/322, 20%) in period B. There was no significant difference in the overall success rate between periods A (90%) and B (98%) (p = 0.08). However, the initial success rate was higher in period B (95%) than in period A (80%) (p < 0.05). The complication rates were not significantly different between the two groups (10% vs 16%; p = 0.56). Although all complications involved pancreatitis, severe pancreatitis was not observed.


CONCLUSIONS
Whereas the initial success rate for NKPP can increase with procedural experience, the complication rate does not seem to decrease. Furthermore, the need for NKPP does not appear to decrease with increasing endoscopic retrograde cholangiopancreatography (ERCP) experience.
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan.
Hirotoshi
H
Fukatsu
Hirofumi
H
Kawamoto
Ryo
R
Harada
Koichiro
K
Tsutsumi
Masakuni
M
Fujii
Hironari
H
Kato
Ken
K
Hirao
Takashi
T
Nakanishi
Osamu
O
Mizuno
Tsuneyoshi
T
Ogawa
Etsuji
E
Ishida
Hiroyuki
H
Okada
Kohsaku
K
Sakaguchi
D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002983:Clinical Competence; D003251:Constriction, Pathologic / Q000601:surgery; D020698:Duodenoscopes; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000193:education* / Q000379:methods