Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla

Table 1 Published data on cannulation via the minor papilla

Ref.	Year	No.	Cannulation procedure	Success (%)	Complication (%)
18	1984	6	Blunt tipped needle catheter	83.3	0
1	1986	6	Flexible Seldinger wire with a dilator and papillotome	100	0
19	1987	18	Needle-tipped catheter or 0.018 inch guidewire	72.9	4.2
11	1990	136	Tapered or needle-tipped catheter + secretin (35% patients)	91	1.5
20	1992	19	Tapered catheter with 0.018 inch guidewire	83	NA
2	2000	25	Tapered catheter with 0.018 or 0.02 inch guidewire	73.5	0
3	2002	24	Tapered catheter with 0.018 inch guidewire	NA	38
23	2003	6	Contour catheter with 0.025 or 0.035 inch wire (rendezvous technique)	100	0
15	2003	14	Methylene blue + needle tipped catheter with 0.018 inch guidewire	85.7	7.1
16	2003	28	Synthetic porcine secretin	89.3	0
4	2004	11	Catheter with 0.025 inch guidewire (including rendezvous technique), needle-knife to minor papilla fistulotomy	90.9	0
21	2006	184	Tapered or metal tip catheter with 0.018 or 0.025 inch guidewire	NA	8.2
6	2008	57	Tapered cannula with a guidewire + secretin (10% patients)	86	11.7
17	2009	64	Pull-sphincterotome with 0.018-0.035 inch guidewire (wire-guided cannulation) + secretin (17% patients)	85	26.5
22	2010	25	Tip sphincterotome with a 0.025 inch guidewire (physician-controlled wire-guided cannulation)	96	12
8	2013	34	Tapered catheter with or without 0.025 inch guidewire	80	4.5
9	2013	48	Tapered cannula and a 0.025 or 0.035 inch guidewire	97.9	2.0
10	2013	45	Tapered-tip or needle-tip catheters, short-nose pull-sphincterotomes, and 0.018-0.035 inch guidewires	91.9	16.1

PD: Pancreas divisum; NA: Not available; No.: Number of patients.

Table 2 Patient data

Basic clinical data	n
Total number of patients	74
Patients that received therapeutic ERCP	70
Patients that received diagnostic ERCP	4
Total cannulation procedures via minor papilla	104
Only using standard method1	79 (56 cases)
Using needle-knife after failure of standard method Using needle-knife at start and standard methods later2	14 (14 cases) 11 (4 cases)3
Age (yr)	40.5 ± 21.8
Children and adolescents (age < 18 yr) (female)	16 (11)
Adults (female)	58 (22)
Clinical indications for cannulation procedures
Pancreatitis	33
Chronic recurrent pancreatic-type pain without enzyme elevation	37
Biliary disease	2
Definite or suspected pancreatic mass	2
Diagnoses
Chronic pancreatitis	13
Pancreas divisum	17
Chronic pancreatitis and pancreas divisum	40
Intraductal papillary mucinous neoplasms	4
Follow-up
Patients who received therapeutic ERCP	70
Patients who received therapeutic ERCP and were followed up	67 (95.7%)
Follow-up period (months)	29.0 ± 22.2
Follow-up results4
Improved	49
Cured	3
Same	7
Worse or much worse	5

¹Using a tapered tip catheter with or without a guidewire;

²Using needle-knife after failure of the standard method in the first and/or second cannulation and only using standard methods in later cannulations;

³Five cannulations using the needle-knife after failure of the standard methods in the first and second cannulations in 4 patients and 6 cannulations using only standard methods in the 4 later cannulations for these cases;

⁴Three patients died prior to follow-up. ERCP: Endoscopic retrograde cholangiopancreatography.

Table 3 Endoscopic retrograde cholangiopancreatography interventions and complications n (%)

	Sphincterotome1 (n = 85)	Needle-knife2 (n = 19)	P value
ERCP procedures in female cases	32 (37.7)	11 (57.9)	0.105
Minor papilla sphincterotomy	493 (57.7)	10 (52.6)	0.690
Dilation	25 (30.5)	4 (21.1)	0.578
Stents	53 (61.0)	11 (57.9)	0.796
ENPD tubes	21 (24.7)	4 (21.5)	1.000
Stents + ENPD tubes	74 (87.1)	15 (79.0)	0.468
Stone extraction and clearance of Santorini’s duct	18 (21.2)	2 (10.5)	0.355
Retrieving of migrated duct stents	1	1	-
Recorded cannulation time (min)4	5.5 ± 4.0	7.3 ± 5.1	0.5053
Post-ERCP complications	4 (4.7)	2 (10.5)	0.301

¹Cannulation using a sphincterotome with or without a guidewire;

²Cannulation with a needle-knife after failure with a sphincterotome;

³Two minor papillotomy procedures using the needle-knife were performed along a guidewire after successful cannulation with the sphincterotome;

⁴Times were recorded in 17 procedures using a sphincterotome and 5 procedures using a needle-knife. ERCP: Endoscopic retrograde cholangiopancreatography; ENPD: Endoscopic naso-pancreatic drainage.

Table 4 Cannulation procedures in adolescents and adults n (%)

	Adolescents1(n = 30)	Adults(n = 74)	P value
Cannulation with needle-knife	5 (16.7)	14 (18.9)	0.788
Stents	20 (66.7)	44 (59.5)	0.494
Cannulation failure	2 (6.7)	6 (8.1)	1.000
Post-ERCP complication	2 (6.7)	4 (5.4)	1.000

¹Patients < 18 years old. ERCP: Endoscopic retrograde cholangiopancreatography.