Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5918-5925
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5918
Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations
Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong
Su Jin Kim, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Su Bum Park, Byeong Jun Song, Young Mi Hong, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 626-770, South Korea
Dae Hwan Kang, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Hospital, Busan 602-739, South Korea
Author contributions: Kim SJ collected the clinical information and was the main author of the manuscript; Kang DH designed the study and performed ERCP; Kim HW performed ERCP; Choi CW performed the statistical analysis; Park SB, Song BJ, Hong YM participated in its design and coordination and helped to draft the manuscript; all authors read and approved the final manuscript.
Supported by a 2-year Research Grant of Pusan National University.
Ethics approval: The study was reviewed and approved by the Pusan National University Yangsan Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: The authors have no conflicts of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at sulsulpul@naver.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dae Hwan Kang, MD, Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri, Mulgeum-eup, Gyeongsangnam-do, Yangsan-si 626-770, South Korea. sulsulpul@naver.com
Telephone: +82-55-360-1535 Fax: +82-55-360-1536
Received: December 3, 2014
Peer-review started: December 5, 2014
First decision: January 22, 2015
Revised: January 30, 2015
Accepted: March 19, 2015
Article in press: March 19, 2015
Published online: May 21, 2015
Processing time: 168 Days and 3.6 Hours
Abstract

AIM: To compare the success rates and adverse events of early needle-knife fistulotomy (NKF) and double-guidewire technique (DGT) in patients with repetitive unintentional pancreatic cannulations.

METHODS: From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography (ERCP) at a single tertiary care hospital (Pusan National University Yangsan Hospital, Yangsan, South Korea) between January 2009 and December 2012, 134 (8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved.

RESULTS: The success rates with early NKF and the DGT were 79.1% (53/67) and 44.8% (30/67) (P < 0.001), respectively. The incidence of post-ERCP pancreatitis (PEP) was lower in the early NKF group than in the DGT group [4.5% (3/67) vs 14.9% (10/67), P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and 312 s (P = 0.013), respectively.

CONCLUSION: Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.

Keywords: Endoscopic retrograde cholangiopancreatography; Cannulation; Pancreatitis; Needle knife fistulotomy; Double guidewire technique

Core tip: This retrospective single center analysis of outcomes of early needle-knife fistulotomy (NKF) and double-guidewire technique (DGT) revealed that early NKF has a higher success rate of selective biliary cannulation with a lower incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis and shorter procedural time than DGT in patients with repetitive unintentional pancreatic cannulations.