Lee MH, Lin CH, Wu CH, Tsou YK, Sung KF, Wang SF, Liu NJ. Pancreatic stent improves the success rate of needle-knife papillotomy in patients with difficult biliary cannulation. World J Gastroenterol 2025; 31(1): 97240 [DOI: 10.3748/wjg.v31.i1.97240]
Corresponding Author of This Article
Yung-Kuan Tsou, MD, Associate Professor, Chief Physician, Doctor, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5 Fuxing Street, Taoyuan 33305, Taiwan. flying@cgmh.org.tw
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
Mu-Hsien Lee, Cheng-Hui Lin, Chi-Huan Wu, Yung-Kuan Tsou, Kai-Feng Sung, Sheng-Fu Wang, Nai-Jen Liu, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
Yung-Kuan Tsou, School of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
Author contributions: Lee MH conception and design; analysis and interpretation of the data; drafting of the article, and critical revision of the article for important intellectual content; Lin CH, Wu CH, Sung KF, Wang SF, Liu NJ analysis and interpretation of the data; Tsou YK conception and design; analysis and interpretation of the data, and critical revision of the article for important intellectual content; final approval of the article. All authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Chang Gung Memorial Hospital (approval number: 202301744B0).
Informed consent statement: As this retrospective study employed routine clinical treatment and diagnostic medical records and did not involve cases of human immunodeficiency virus infection, the Chang Gung Medical Foundation Institutional Review Board waived the requirement for participant consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Deidentified individual participant data are available and will be provided on reasonable request to the corresponding author. The study protocol and analytic codes are also available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yung-Kuan Tsou, MD, Associate Professor, Chief Physician, Doctor, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5 Fuxing Street, Taoyuan 33305, Taiwan. flying@cgmh.org.tw
Received: May 26, 2024 Revised: October 25, 2024 Accepted: November 15, 2024 Published online: January 7, 2025 Processing time: 196 Days and 20.5 Hours
Abstract
BACKGROUND
Needle-knife precut papillotomy (NKP) is typically performed freehand. However, it remains unclear whether pancreatic stent (PS) placement can improve the outcomes of NKP.
AIM
To explore whether PS placement improves the success rate of NKP in patients with difficult biliary cannulation.
METHODS
This single-center retrospective study included 190 patients who underwent NKP between January 2017 and December 2021 after failed conventional biliary cannulation. In cases with incidental pancreatic duct cannulation during conventional biliary cannulation, the decision for pre-NKP PS placement was made at the endoscopist's discretion. The primary outcome was the difference in the NKP success rate between patients with and without PS placement; the secondary outcome was the adverse event rate.
RESULTS
Among the 190 participants, 82 received pre-NKP PS (PS-NKP group) whereas 108 did not [freehand or freehand NKP (FH-NKP) group]. Post-NKP selective biliary cannulation was successful in 167 (87.9%) patients, and the PS-NKP had a significantly higher success rate than the FH-NKP group (93.9% vs 83.3%, P = 0.027). The overall adverse event rates were 7.3% and 11.1% in the PS-NKP and FH-NKP groups, respectively (P = 0.493). A periampullary diverticulum (PAD) and significant intraoperative bleeding during NKP were independently associated with NKP failure; however, a pre-NKP PS was the only predictor of NKP success. Among the 44 participants with PADs, the PS-NKP group had a non-significantly higher NKP success rate than the FH-NKP group (87.5% and 65%, respectively; P = 0.076).
CONCLUSION
PS significantly improved the success rate of NKP in patients with difficult biliary cannulation.
Core Tip: This observational study showed that pancreatic stent (PS) placement aids identification of the direction of the common bile duct and increases the success rate of needle-knife papillotomy in patients with difficult biliary cannulation, especially with less experienced operators. Significant bleeding during needle-knife papillotomy and in patients with a periampullary diverticulum can detract from the success of the procedure. Although PS placement tends to improve the success rate of needle-knife papillotomy, randomized controlled trials are required to validate the results.
