Retrospective analysis of needleknife precut papillotomy in our practice

Endoscopic retrograde cholangiopancreatography (ERCP) has generally become a therapeutic tool. Due to significant complications, diagnostic procedures are replaced by less invasive imaging modalities.

Aim and Methods: We retrospectively analyzed the indications, success and outcome of ERCP procedures performed in year 2008at the new endoscopic facility of Regional Diagnostic Center, University of Pécs. The effectiveness of needleknife precut (NK) was specifically evaluated in our analysis.

Results: We perfomed 384 ERCP procedures in 2008 (M: 38%, F:62%). Indications were: biliary obstruction with jaundice in 79 patients (pts) (20.6%), obstruction without jaundice in 115 pts (29.7%), acute biliary pancreatitis in 49 pts (12.7%), cholangitis in 18 pts (4.8%), cholangiohepatitis in 32 pts (8.4%), abdominal pain (without any other abnormality) in 20 pts (5.4%) and elective procedure in 71 pts (18.2%). Serum bilirubin was elevated in 196 pts (51%), transaminases were elevated 246 (64%) of pts. The primary goal of the ERCP was not achieved in 81 pts (21%) due to different reasons. 84% of these unsuccessful procedures were repeated. NK was used in 54 pts (14.1% of all procedures) to facilitate biliary access, while regular papillotomy (RP) was performed in 153 pts (39.5%). NK resulted common bile duct cannulation during the first procedure in 10.9% of cases (42 pts), during second procedure in 1.5% of cases (6 pts), and during the third procedure in case of three (0.78%) pts. The following complications were observed: 1) haemorrhage (both mild and significant) developed in 9 pts (16%) from the NK group and 18 (11.7%) pts from the RP group; 2) post ERCP pancreatitis was observed in 14 pts (26%) after NK versus 7 pts (4.5%) in the RP group; 3) retroperitoneal perforation was observed in two cases after NK, both pts recovered without abdominal surgery.

Conclusion: Use of needleknife is a helpful tool for biliary access in case of unsuccessful biliary canulation during ERCP, but it requires thoughtful use due to higher risk of possible serious complications.