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Needle knife papillotomy for cannulating difficult papilla; two years experience.

OBJECTIVE
To evaluate the success rate and complications of precut-papillotomy using a needle knife, for cannulating difficult papilla during Endoscopic retrograde cholangiopancreatography.


METHODS
Records of patients requiring a pre-cut with needle knife to access the common bile duct or pancreatic duct during a two year period wore analyzed retrospectively. The success rates and complications of needle knife papillotomy were specifically looked for along with the underlying diagnosis.


RESULTS
From January 2005 to December 2006, 515 ERCPs were performed at two private centers in Karachi by a single operator. Of these 59 patients required needle knife papillotomy to access the common bile duct with a success rate of 95% (56 patients). In 39 cases, CBD was cannulated immediately while in 15, two attempts were required and in 2 cases successful cannulation was possible at the third attempt. There were three failures. Among these one had a large duodenal diverticulum, one opted for a percutaneous drainage after first attempt and the third was lost to follow up after the first attempt. No major complications occurred from needle knife pre-cut papillotomy in this series. Three patients (5%) had minor bleeding out of which one required Adrenaline injection for maintenance of haemostasis. Two patients (3.38%), developed mild pancreatitis requiring conservative management. There were no major bleeds, perforations, biliary sepsis or deaths.


CONCLUSION
Needle-knife papillotomy increases the success of diagnostic and therapeutic procedures during ERCP. In the present series, minimal complications occurred as a result of precut, papillotomy.