Mo1488 Long Term Follow-Up After Needle Knife Sphincterotomy for Biliary Access: A Blinded Comparative Clinical, Sonographic and Endoscopic Study

Abstract

Needle Knife Sphincterotomy (NKS) or precut is an important salvage technique in difficult biliary cannulation during Endoscopic Retrograde Cholangiopancreatography(ERCP). Recent data suggests that NKS may be safer than repeated standard attempts at biliary cannulation, however data on long term outcomes after NKS is absent. Sequential NKS patients were analysed from a clinical trials ERCP database consisting of 3 successive, prospective naïve papilla ERCP cannulation trials of 1232 patients. Two control groups of 145 patients each without NKS: ‘Early Cannulation’(1-4 attempts) and ‘Late Cannulation’(>4 attempts) were also randomly selected and matched for age, follow-up time and indications for ERCP. All patients had biliary sphincterotomy at initial ERCP. Patients were mailed a validated screening biliary symptom assessment questionnaire, followed by a telephone interview in non-respondents. Those with suspected biliary symptoms were assessed clinically and with ultrasound and liver function tests by a Gastroenterologist blinded to all previous ERCP data. Patients with true biliary symptoms or abnormal investigations were evaluated by ERCP with balloon impaction cholangiography and 10mm balloon pull through. Results were analyzed using the Fisher Exact or Pearson's Chi Square tests as appropriate. After allowing for those patients that were deceased or lost to follow-up, a total of 183 patients were available(112 females, mean age 60 years; range 21-91). Table 1 summarizes the results.Of those patients with true biliary symptoms, only 1 patient had an abnormal ultrasound. Liver function tests were essentially normal in all. Standardised ERCP was performed in the 7 patients with true biliary symptoms and was found to be normal in all.Table 1CriterionNKS n=124Early Cannulation n=145Late Cannulation n=145p-valueNumber of patients lost to follow-up455954Number of deceased patients281827Number of evaluable patients516864Mean follow-up time in years (SD)5.1 (1.4)5.4 (1.4)5.6 (1.5)NSSymptomatic on screening questionnaire N(%)12(23.5)9(13.2)7(10.9)NSPrevalence of true biliary symptoms-N (%)1(2.0)4(5.9)2(3.1)NS Open table in a new tab In long term follow-up, NKS is not associated with an increased incidence of biliary symptoms when compared to Early or Late Cannulation controls. In all groups symptomatic biliary stenosis is uncommon. NKS does not lead to late biliary complications.