Needle Knife Fistulotomy Versus Partial Ampullary Endoscopic Mucosal Resection for Difficult Biliary Cannulation: a prospective randomised controlled trial

Aims Cannulation success with standard techniques is reported to be around 90%. Even in expert hands and despite all efforts, it can be challenging that needs an alternate intervention. Needle-knife fistulotomy (NKF) is recommended as the initial technique for pre-cutting because the rate of post-ERCP pancreatitis (PEP) is significantly low. Still, it's performed as a free-hand technique without using a guidewire which may cause complications such as perforation and bleeding. We recently described a novel technique; partial ampullary mucosal resection (PA-EMR) for difficult biliary cannulation which may overcome some of NKF's limitations. Our aim was to compare the efficacy and safety of PA-EMR vs NKF [1] [2] [3] [4].

Methods The detailed information can be seen at: ClinicalTrials.gov (ID: NCT05068739) ([Table 1]).

Table 1

Results The characteristics of the patients and procedure related characterstics arepresented in Table-1.

Conclusions Our results imply that PA-EMR has a comparable efficacy and safety profile against NKF. Moreover, the rate of complications may be lower and cannulation success in the first session may be higher. Multicenter studies with larger cohorts are needed to verify these preliminary results.

Publication History

Article published online:
14 April 2023

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