Primary Needle-Knife Sphincterotomy for Biliary Access in Patients at High Risk of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.

Jin-Seok Park,Seok Jeong,Don Haeng Lee,Mohamed O Othman

doi:10.1155/2021/6662000

Jin-Seok Park, Seok Jeong + Show 2 more

Open Access

https://doi.org/10.1155/2021/6662000

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Abstract

Methods Forty patients with one or more risk factors for PEP were prospectively enrolled between June 2018 and November 2019. The cannulation was conducted in all patients using NKS as the primary cannulation technique. Success rate of biliary cannulation, biliary cannulation time, and adverse event rate were assessed. Results Of the 40 patients enrolled, 34 patients underwent primary NKS after the screening. Nine patients had 1 risk factor for PEP, 7 had 2, 8 had 3, 7 had 4, and 3 had 5. The success rate of biliary access by NKS was 94.1% (32/34). The median procedure time for NKS and the total procedure time for stone removal or biliary drainage were 4.1 minutes (range, 0.5-25.2) and 11.3 minutes (range, 3.8–40.4), respectively. Adverse events occurred in two patients (minor bleeding, n = 1; hyperamylasemia, n = 1). No patient experienced PEP or perforation. Conclusion NKS might be feasible as a primary cannulation procedure in patients at high risk of PEP. This trial is registered with KCT0004886 (03/06/2018).

Highlights

Endoscopic retrograde cholangiopancreatography (ERCP) has become a standard procedure for the diagnosis and treatment of pancreaticobiliary diseases [1]
Forty patients who had at least one of the patient-related risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) were diagnosed as having biliary diseases which required ERCP
The present study suggests primary Needle-knife sphincterotomy (NKS) might be a reasonable procedure for biliary access in patients that require ERCP, especially in patients at increased risk of PEP

Summary

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) has become a standard procedure for the diagnosis and treatment of pancreaticobiliary diseases [1]. Post-ERCP pancreatitis (PEP) is the most common adverse event following the procedure with a range from 2% to 10% in nonselective cases and can cause substantial morbidity, mortality, and high medical costs [2]. Due to recent advances in endoscopic techniques, the successful biliary cannulation rate has been improved and the incidence of PEP has decreased. The aim of the current study was to investigate the feasibility, efficacy, and safety of NKS when used for primary access in patients at high risk of developing postendoscopic retrograde cholangiopancreatography pancreatitis (PEP). NKS might be feasible as a primary cannulation procedure in patients at high risk of PEP. This trial is registered with KCT0004886 (03/06/2018)

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Conclusion