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Endoscopy 2017; 49(09): 874-887
DOI: 10.1055/s-0043-111717
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Transpancreatic sphincterotomy has a higher cannulation success rate than needle-knife precut papillotomy – a meta-analysis

Dániel Pécsi
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
Nelli Farkas
3   Institute of Bioanalysis, University of Pécs, Pécs, Hungary
,
Péter Hegyi
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
4   Hungarian Academy of Sciences – University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
,
Márta Balaskó
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
József Czimmer
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
,
András Garami
2   Institute for Translational Medicine, University of Pécs, Pécs, Hungary
,
Anita Illés
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
,
Dóra Mosztbacher
5   First Department of Paediatrics, Semmelweis University, Budapest, Hungary
,
Gabriella Pár
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
,
Andrea Párniczky
6   Heim Pál Children’s Hospital, Budapest, Hungary
,
Patrícia Sarlós
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
,
Imre Szabó
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
,
Kata Szemes
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
,
Ákos Szűcs
7   First Department of Surgery, Semmelweis University, Budapest, Hungary
,
Áron Vincze
1   Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
› Author Affiliations
Further Information

Publication History

submitted 15 January 2017

accepted after revision 20 April 2017

Publication Date:
13 June 2017 (online)

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Flail, flay, or fail: needle-knife versus transpancreatic sphincterotomy to access the difficult-to-cannulate bile duct during ERCPEndoscopy 2017; 49(09): 842-843
DOI: 10.1055/s-0043-117045

Abstract

Background and aim While many studies have discussed the different cannulation techniques used in patients with difficult biliary access, no previous meta-analyses have compared transpancreatic sphincterotomy (TPS) to other advanced techniques. Therefore, we aimed to identify all studies comparing the efficacy and adverse event rates of TPS with needle-knife precut papillotomy (NKPP), the most commonly used technique, and to perform a meta-analysis.

Methods The Embase, PubMed, and Cochrane databases were searched for trials comparing the outcomes of TPS with NKPP up till December 2016. A meta-analysis focusing on outcome (cannulation success, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP), post-procedural bleeding, and total adverse events) was performed. The population, intervention, comparison, outcome (PICO) format was used to compare these cannulation approaches. Five prospective and eight retrospective studies were included in our meta-analysis.

Results NKPP has a significantly lower success rate (odds ratio [OR] 0.50, P = 0.046; relative risk [RR] 0.92, P = 0.03) and a higher rate of bleeding complications (OR 2.24, P = 0.02; RR 2.18, P = 0.02) than TPS. However, no significant differences were found in PEP (OR 0.79, P = 0.24; RR 0.80, P = 0.19), perforation (risk difference [RD] 0.01, P = 0.23), or total complication rates (OR 1.22, P = 0.44; RR 1.17, P = 0.47).

Conclusion While TPS has a higher success rate in difficult biliary access and causes less bleeding than NKPP, there are no differences in PEP, perforation, or total complication rates between the two approaches. We conclude that TPS, in the hands of expert endoscopists, is a safe procedure, which should be used more widely in patients with difficult biliary access.

Fig. e2 – e5, Table e1,

 

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