Needle Knife Sphincterotomy and the Risk of Post-ERCP Complications: A Tertiary Center Experience

Abstract

Purpose: Endoscopic retrograde cholangiographic pancreatography (ERCP) is successful in 90% of patients to achieve biliary cannulation. Needle knife sphincterotomy (NKS) has been advocated in patients which routine cannulation is not possible. Our aim was to evaluate the efficacy of cannulation and complication risk of NKS in our institution. Methods: Retrospective analysis of 706 ERCPs in which NKS was performed from 2001-2011. The cannulation was accomplished with a guide wire and NKS was used in difficult cases to gain access into the biliary duct. If the primary cannulation failed, and the wire went only into the pancreatic duct, pancreatic sphincterotomy was performed and pancreatic duct stent was placed. Results: A total of 706 patients required NKS in our cohort of which 614 (86.9%) had successful biliary cannulation. A total of 318 (45%) patients had pancreatic duct stent placed prior to NKS. In our cohort of patients who underwent NKS, post-ERCP pancreatitis (PEP) was diagnosed in 57, perforation in 6 (0.8) and bleeding in 46 (6.5%) patients. In patients with unsuccessful NKS, the risk of PEP with and without a pancreatic duct stent placement was 12.7% and 6.7% respectively. (P=0.67) In patients with successful NKS with biliary cannulation, the risk of PEP with and without a pancreatic duct stent placement was 9.6% and 6.4%, respectively. (P=0.60) Also, the risk of developing any complication in the successful NKS group did not differ in patients with and without a pancreatic duct stent placed. (14% vs. 11.1%, P=0.56) Conclusion: In patients with failed primary cannulation, NKS is successful in achieving biliary access in most patients. The use of a pancreatic duct stent prior to NKS did not appear to impact the risk of complications