title: Early use of needle-knife fistulotomy is safe in situations where difficult biliary cannulation is expected.
abstract: OBJECTIVE
  Difficult cannulation is a well known risk for post-ERCP pancreatitis. This study evaluated the outcomes of needle-knife fistulotomy (NKF) used prior to being faced with difficult biliary cannulation.
  
  
  METHODS
  Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of biliary endotherapy between January 2007 and December 2008 were eligible for this study; 218 patients were recruited. Biliary cannulation was performed only by a standard catheter or a pull type papillotome, without wire-guided assistance in all patients. If selective cannulation was not achieved within five cannulation attempts, NKF was performed, and the results were compared with the easy cannulation group that succeeded biliary cannulation within five attempts.
  
  
  RESULTS
  Needle-knife fistulotomy (NKF) was performed in 72 (33.0%) of the 218 patients. The total success rate of the ERCP was 98.2% (214/218), and for the NKF group the success rate was 94.4% (68/72). The rate of complications in patients with NKF did not increase compared to patients in the easy cannulation group (P > 0.05): 4.2% (3/72) versus 3.4% (5/146) for acute pancreatitis, 6.9% (5/72) versus 6.8% (10/146) for bleeding, and 1.4% (1/72) versus 0% (0/146) for perforation, respectively.
  
  
  CONCLUSIONS
  Our results suggest that the use of NKF for biliary cannulation might be safe and effective. Therefore, in experienced hands, early use of NKF might be recommended.
authors.affiliation: Department of Gastroenterology, Kyung Hee University Hospital at Gangdong, 892 dongnam-lo, Gangdong-gu, Seoul 134-727, Korea.
authors.forename: Jun Uk
authors.initials: JU
authors.lastname: Lim
authors.forename: Kwang Ro
authors.initials: KR
authors.lastname: Joo
authors.forename: Jae Myung
authors.initials: JM
authors.lastname: Cha
authors.forename: Hyun Phil
authors.initials: HP
authors.lastname: Shin
authors.forename: Joung Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Park
authors.forename: Jung Won
authors.initials: JW
authors.lastname: Jeon
authors.forename: Bum-Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Sunhyung
authors.initials: S
authors.lastname: Joo
mesh_terms: D001660:Biliary Tract Diseases / Q000473:pathology / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010183:Pancreatic Ducts / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D012421:Rupture / Q000209:etiology / Q000517:prevention & control; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013525:Surgical Instruments / Q000592:standards*