Han SY, Baek DH, Kim DU, Park CJ, Park YJ, Lee MW, Song GA. Primary needle-knife fistulotomy for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: Importance of the endoscopist’s expertise level. World J Clin Cases 2021; 9(17): 4166-4177 [PMID: 34141779 DOI: 10.12998/wjcc.v9.i17.4166]
Corresponding Author of This Article
Dong Uk Kim, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, South Korea. amlm3@hanmail.net
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/
World J Clin Cases. Jun 16, 2021; 9(17): 4166-4177 Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4166
Primary needle-knife fistulotomy for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: Importance of the endoscopist’s expertise level
Sung Yong Han, Dong Hoon Baek, Dong Uk Kim, Chang Joon Park, Young Joo Park, Moon Won Lee, Geun Am Song
Sung Yong Han, Dong Hoon Baek, Dong Uk Kim, Chang Joon Park, Young Joo Park, Moon Won Lee, Geun Am Song, Division of Gastroenterology and Hepatology, Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
Author contributions: Kim DU and Song GA contributed study concept and design; Park CJ and Park YJ contributed data acquisition; Han SY and Lee MW contributed data analysis and interpretation; Han SY and Baek DH contributed drafting of the manuscript; Kim DU and Song GA contributed critical revision of the manuscript.
Supported byKorea Medical Device Development Fund Grant Funded by the Korea Government the Ministry of Trade, Industry and Energy (Project Number: 9991007196), No. KMDF_PR_20200901_0066.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the Pusan National University (approval No. H-1805-023-067).
Informed consent statement: Signed informed consent forms were waived by the Institutional Review Board of the Pusan National University.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Data sharing statement: No additional data are 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong Uk Kim, MD, PhD, Associate Professor, Division of Gastroenterology and Hepatology, Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, South Korea. amlm3@hanmail.net
Received: March 8, 2021 Peer-review started: March 8, 2021 First decision: March 27, 2021 Revised: April 5, 2021 Accepted: April 20, 2021 Article in press: April 20, 2021 Published online: June 16, 2021
Abstract
BACKGROUND
Needle-knife fistulotomy (NKF) is used as a rescue technique for difficult cannulation. However, the data are limited regarding the use of NKF for primary biliary cannulation, especially when performed by beginners.
AIM
To assess the effectiveness and safety of primary NKF for biliary cannulation, and the role of the endoscopist’s expertise level (beginner vs expert).
METHODS
We retrospectively evaluated the records of 542 patients with naïve prominent bulging papilla and no history of pancreatitis, who underwent bile duct cannulation at a tertiary referral center. The patients were categorized according to the endoscopist’s expertise level and the technique used for bile duct cannulation. We assessed the rates of successful cannulation and adverse events.
RESULTS
The baseline characteristics did not differ between the experienced and less-experienced endoscopists. The incidence rate of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) was significantly affected by the endoscopist’s expertise level in patients who received conventional cannulation with sphincterotomy (8.9% vs 3.4% for beginner vs expert, P = 0.039), but not in those who received NKF. In the multivariable analysis, a lower expertise level of the biliary endoscopist (P = 0.037) and longer total procedure time (P = 0.026) were significant risk factor of PEP in patients who received conventional cannulation with sphincterotomy but only total procedure time (P = 0.004) was significant risk factor of PEP in those who received NKF.
CONCLUSION
Primary NKF was effective and safe in patients with prominent and bulging ampulla, even when performed by less-experienced endoscopist. We need to confirm which level of endoscopist’s experience is needed for primary NKF through prospective randomized study.
Core Tip: Needle-knife fistulotomy (NKF) is used as a rescue technique for difficult cannulation. However, the data are limited regarding the use of NKF for primary biliary cannulation, especially when performed by beginners. Our retrospective study aims to assess the effectiveness and safety of primary NKF for biliary cannulation, and the role of the endoscopist’s expertise. The incidence rate of post-endoscopic retrograde cholangiopancreatography pancreatitis was significantly affected by the endoscopist’s expertise level in patients who received conventional cannulation with sphincterotomy, but not in those who received NKF. Primary NKF may be effective and safe in achieving ductal access in patients with naïve papilla, regardless of experience.
