Endoscopic treatment for pancreatic diseases：Needle-knife-guided cannulation via the minor papilla

• Published in: World journal of gastroenterology : WJG 2015-05, Vol.21 (19), p.5950-5960
• Main Authors: Wang, Wei, Gong, Biao, Jiang, Wei-Song, Liu, Lei, Bielike, Kouken, Xv, Bin, Wu, Yun-Lin
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cannulation; Meticulous; Catheterization - adverse effects; Catheterization - methods; Child; cholangiopancreatography; Cholangiopancreatography, Endoscopic Retrograde - adverse effects; Cholangiopancreatography, Endoscopic Retrograde - methods; Endoscopic; Female; Humans; Male; Minor; Needle-knife; Pancreatic Diseases - diagnosis; Pancreatic Diseases - surgery; Pancreatic Ducts - diagnostic imaging; Pancreatic Ducts - pathology; Pancreatic Ducts - surgery; papilla; Postoperative Complications - etiology; Predictive Value of Tests; procedure; retrograde; Retrospective Studies; Retrospective Study; Sphincterotomy, Endoscopic - adverse effects; Sphincterotomy, Endoscopic - methods; Time Factors; Treatment Outcome
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i19.5950

AIM To determine the efficacy and safety of meticulouscannulation by needle-knife.METHODS： Three needle-knife procedures were usedto facilitate cannulation in cases when standard cannulationtechniques failed. A total of 104 cannulationsvia the minor papilla attempted in 74 patients at ourcenter between January 2008 and June 2014 wereretrospectively reviewed.RESULTS： Standard methods were successful in79 cannulations. Of the 25 cannulations that couldnot be performed by standard methods, 19 wereperformed by needle-knife, while 17 （89.5%） weresuccessful. Needle-knife use improved the successrate of cannulation [76.0%, 79/104 vs 92.3%, （79 ＋17）/104; P = 0.001]. When the 6 cases not appropriatefor needle-knife cannulation were excluded, thesuccess rate was improved further （80.6%, 79/98 vs98.0%, 96/98; P = 0.000）. There were no significantdifferences in the rates of post-endoscopic retrogradecholangiopancreatography adverse events between thegroup using standard methods alone and the groupusing needle-knife after failure of standard methods（4.7% vs 10.5%, P = 0.301）.CONCLUSION： The needle-knife procedure may bean alternative method for improving the success rateof cannulation via the minor papilla, particularly whenstandard cannulation has failed.