Comparative analysis of endoscopic precut conventional and needle knife sphincterotomy

Table 1 Patient characteristics-risk factor

	Needle-knife PNK (n = 84)	Conventional PCS (n = 59)	P value
Female	43	38	0.16
Age < 50 yr	16	7	0.36
Bilirubin level (norm)	8	10	0.30
Concomitant systemic diseases	20	6	0.06
Neoplasms	26	17	0.96
Retention cause
Choledocholithiasis	24	23	0.26
Papillar stenosis	14	10	0.85
Distal stenosis	18	13	0.70
Middle stenosis	3	5	0.37
Hilum stenosis	5	4	0.88
Anatomy of the papilla
Flat	28	23	0.60
Prominent	32	23	0.94
In diverticulum	12	10	0.84
Tumor	18	5	0.06
Biliary duct diameter
(mean)	14.49	14.07	0.42
(< 9 mm)	18	13	0.90
Accesory procedures
Prosthesis implantation
CBD	65	51	0.83
Wirsung	11	2	0.08
Prosthesis in CBD diam. (mean)	6.01	5.89	0.59
Pathological sampling	12	3	0.13

CBD: Common bile duct; PCS: Pre-cut conventional sphincterotomy; PNK: Pre-cut needle knife.

Table 2 Comparison of the efficacy and complication rates of pre-cut conventional sphincterotomy and pre-cut needle knife procedures

Procedure	PNK (n = 84)	PCS (n = 59)	P value
Two-step access	41	5	< 0.0001
Efficacy	84	57	0.58
Amylase level (after 4 h)
> 80 U/L	41	23	0.32
> 240 U/L	19	11	0.71
Pancreatic pain (after 24 h)	13	7	0.71
PEP	4	2	0.98
“Endoscopic” bleeding	10	8	0.97
Endoscopic homeostasis	10	7	0.79
Perforation	0	0	-

PEP: Post endoscopic pancreatitis; PCS: Pre-cut conventional sphincterotomy; PNK : Pre-cut needle knife.

Table 3 Logistic regression-Hyperamylasemia (> 80 U/L) 4 h after the procedure and its association with indication, Vater’s papilla anatomy and additional procedures

	Conventional (PCS)		Needle knife (PNK)
Parameter	P	OR	P	OR
Indications
Lithiasis	1.4	0.73	0.19	0.52
Distal stenosis	0.98	1.01	0.98	0.96
Middle stenosis	0.38	0.52	0.55	0.67
CBD diam. < 9 mm	0.96	0.97	0.9	1.06
Bilirubin level - N	0.43	1.72	0.42	1.8
Vater’s papilla anatomy
Flat	0.0271	3.38	0.22	0.56
Prominent	0.034	0.28	0.86	1.0
In diverticulum	0.52	0.62	0.93	1.05
Tumor	0.96	1.04	0.9	1.06
Additional procedures
CBD prosth. diam. < 6 Fr	0.13	5.3	0.56	0.7
Endoscopic haemostasis	0.82	1.2	0.049	5.42
Specimen sampling	0.84	0.78	0.92	1.06

¹Statistically significant only in unifactor logistic regression;

²Statistically significant only in multifactor logistic regression. CBD: Common bile duct; OR: Odds ratio; PCS: Pre-cut conventional sphincterotomy; PNK: Pre-cut needle knife.

Table 4 Frequency of pre-cut sphincterotomy with a two-step approach, and efficacy of common bile duct cannulation (pre-cut conventional sphincterotomy and pre-cut needle knife procedures)

Ref.	PS freq.	PS technique	Two-step	Efficacy
Slot et al[1]	16.5%	PNK	12%	99%
Kasmin et al[14]	18.0%	PNK	32%	93%
Huigbregtse et al[21]	19.2%	PNK	47%	91%
Dowsett et al[25]	12.8%	PNK	54%	96.2%
Shakoor et al[26]	3.8%	PNK	13%	85%
Leung et al[27]	3.9%	PNK	15%	95%
Own material	20.9 %	PNK	48%	100%
	14.7%	PCS	8.5%	94.4%
Binmoeller et al[11]	38%	PCS	9%	100%
Goff et al[12]	44.0%	PCS	14%	97%

PS: Pre-cut sphincterotomy; PCS: Pre-cut conventional sphincterotomy; PNK: Pre-cut needle knife.

Table 5 Complication rates after pre-cut sphincterotomy

Ref.	Pts. No.	PS type	Start of cut	All complications	PEP	Bleeding	Perforation
Slot et al[1]	-	PNK	Orifice	12%	0.5%	5.5%	3%
Kasmin et al[14]	72/398	PNK	Centre	11%	3.8%	3.8%	3.8%
Huibregtse et al[21]	190/987	PNK	Orifice	2.6%	1.0%	1.5%	0%
Dowsett et al[25]	96/748	PNK	Orifice	5.20%	1.0%	4%	0%
Shakoor et al[26]	53/1367	PNK	Orifice	11%	5.5%	3.7%	1.8%
Leung et al[27]	20/510	PNK	Centre	20%	0%	20%	0%
Donnellan et al[28]	352/2603	PNK	Centre	4.8%	1.0%	4.2%	0.3%
Our data	84/402	PNK	Centre	4.80%	5.4%	0%	0%
	59/402	PCS	-	3.4%	3.4%	0%	0%
Binmoeller et al[11]	123/327	PCS	-	5.3%	2.7%	2.4%	0%
Goff et al[12]	32/110	PCS	-	12%	12%	0%	0%

PS: Pre-cut sphincterotomy; PEP: Pos-ercp pancreatitis; PCS: Pre-cut conventional sphincterotomy; PNK : Pre-cut needle knife.