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.