title: Outcome of repeat ERCP after initial failed use of a needle knife for biliary access.
abstract: BACKGROUND
  A needle knife is often used to gain bile duct access when standard techniques have failed. If unsuccessful, the next step may involve either radiological- or endoscopic ultrasound-guided biliary access. However, repeat endoscopic retrograde cholangiopancreatography (ERCP) may be an option if the patient's clinical condition permits.
  
  
  OBJECTIVE
  To determine the success of repeat ERCP after failed use of a needle knife to gain biliary access.
  
  
  METHODS
  Retrospective analysis of all patients who underwent initial unsuccessful biliary cannulation after use of a needle knife between 2007 and 2010.
  
  
  RESULTS
  Seventy five patients were identified. Of these, 51 (68%) underwent repeat ERCP, and biliary cannulation was successful in 38 (75%). The median time to repeat ERCP was 7.7 days (range 1-28 days). Complications developed in two (4%) patients. These included one case each of wire-guided perforation and mild pancreatitis, both of which were resolved by conservative management.
  
  
  CONCLUSIONS
  Repeat ERCP within a few days after failed use of a needle knife for biliary access is associated with acceptable success and acceptable incidence of complications, and therefore obviates the need for alternative approaches for biliary access for most patients.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Vancouver General Hospital, Vancouver, BC, Canada. fdonnellan77@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Donnellan
authors.forename: R
authors.initials: R
authors.lastname: Enns
authors.forename: E
authors.initials: E
authors.lastname: Kim
authors.forename: E
authors.initials: E
authors.lastname: Lam
authors.forename: J
authors.initials: J
authors.lastname: Amar
authors.forename: J
authors.initials: J
authors.lastname: Telford
authors.forename: M F
authors.initials: MF
authors.lastname: Byrne
mesh_terms: D001652:Bile Ducts / Q000601:surgery*; D001661:Biliary Tract Neoplasms / Q000175:diagnosis; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D042883:Choledocholithiasis / Q000175:diagnosis; D019160:Endosonography; D006801:Humans