title: Comparison between needle-knife fistulotomy and standard cannulation in ERCP.
abstract: OBJECTIVE
  To compare the rates of success and complications of two different methods of access into the common bile duct (CBD).
  
  
  METHODS
  Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi's syndrome.
  
  
  RESULTS
  Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS).
  
  
  CONCLUSIONS
  Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.
authors.affiliation: Mohammad Ayoubi, Gianni Sansoè, Nicola Leone, Francesca Castellino, Endoscopy unit, Gradenigo Hospital, 10153 Torino, Italy.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ayoubi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sansoè
authors.forename: Nicola
authors.initials: N
authors.lastname: Leone
authors.forename: Francesca
authors.initials: F
authors.lastname: Castellino
keywords: Biliary stones; Common bile duct; Fistulotomy; Pancreatitis; Papillotomy