Feasibility of using wire-guided needle-knife electrocautery for refractory biliary and pancreatic strictures.
BACKGROUND
Endoscopic management of biliary or pancreatic strictures by stent insertion is well established. However, some high-grade strictures are refractory to dilation and stent placement with conventional methods.


OBJECTIVE
To evaluate the safety and efficacy of the wire-guided electrotomy technique in dilating stiff biliary and/or pancreatic stenoses when ordinary methods failed.


METHODS
Retrospective analysis of a prospective database.


METHODS
Tertiary referral university hospital.


METHODS
This study involved 279 patients with biliary or pancreatic strictures who underwent ERCP for stenting.


METHODS
After conventional dilation failed, wire-guided needle-knife electrocautery was attempted to facilitate insertion of the dilating devices and eventually endoprosthesis.


METHODS
The successful treatment and drainage of biliary or pancreatic strictures.


RESULTS
With wire-guided needle-knife cauterization, the success rate of stricture dilatation increased from 95.7% (267 of 279 patients) to 98.9% (276 of 279 patients). Dilation of stenoses was successful in 9 of 10 patients (90%) by using electrocautery with the wire-guided needle-knife technique. Postprocedure adverse events included self-limited bleeding, mild acute pancreatitis, hyperamylasemia, cholangitis, and biliary perforation. No procedure-related death occurred.


CONCLUSIONS
Retrospective, single-center study and small sample size.


CONCLUSIONS
Wire-guided needle-knife electroincision appears to be effective for traversing refractory biliary or pancreatic strictures and can be considered as an alternative approach to conventional methods. However, the safety of such a technique needs to be further evaluated.
Department of Endoscopy, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai 200438, China.
Dao-jian
DJ
Gao
Bing
B
Hu
Ya-min
YM
Pan
Tian-tian
TT
Wang
Ju
J
Wu
Rui
R
Lu
Shu-ping
SP
Wang
Zhi-mei
ZM
Shi
Hui
H
Huang
Shu-zhi
SZ
Wang
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries / Q000473:pathology* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology; D003251:Constriction, Pathologic / Q000601:surgery; D004106:Dilatation; D004322:Drainage / Q000379:methods; D004564:Electrocoagulation / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery; D010195:Pancreatitis / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D017211:Treatment Failure