title: Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations.
abstract: OBJECTIVE
  To compare the success rates and adverse events of early needle-knife fistulotomy (NKF) and double-guidewire technique (DGT) in patients with repetitive unintentional pancreatic cannulations.
  
  
  METHODS
  From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP) at a single tertiary care hospital (Pusan National University Yangsan Hospital, Yangsan, South Korea) between January 2009 and December 2012, 134 (8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved.
  
  
  RESULTS
  The success rates with early NKF and the DGT were 79.1% (53/67) and 44.8% (30/67) (P < 0.001), respectively. The incidence of post-ERCP pancreatitis (PEP) was lower in the early NKF group than in the DGT group [4.5% (3/67) vs 14.9% (10/67), P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and 312 s (P = 0.013), respectively.
  
  
  CONCLUSIONS
  Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Dae Hwan
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Choi
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Su Bum
authors.initials: SB
authors.lastname: Park
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Byeong Jun
authors.initials: BJ
authors.lastname: Song
authors.affiliation: Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Hong
mesh_terms: D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D003135:Common Bile Duct; D004867:Equipment Design; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis / Q000453:epidemiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cannulation; Double guidewire technique; Endoscopic retrograde cholangiopancreatography; Needle knife fistulotomy; Pancreatitis