Technical overview of difficult biliary cannulation in endoscopic retrograde cholangiopancreatography: A guide for the endoscopist

Table 1 Studies (randomized controlled trials) comparing needle knife vs other techniques for difficult biliary cannulation during endoscopic retrograde cholangiopancreatography, n (%)/mean ± SD

Ref.	Definition of DBC	Endoscopist experience	Sample size	Baseline characterstics; age	Baseline characterstics; gender (male %)	Groups (n)	Cannulation rate	Bleeding	Perforation	PEP	Comments
Mavrogiannis et al[6], 1999	Failure to cannulate for more than 15 minutes by fellow and more than 20 minutes by experienced endoscopist; PD cannulation up to 5 times	Not defined	153	NKPP: 62.1 (29-83); NKF: 59.3 (20-91)	NKPP: 24 (30); NKF: 22 (29)	NKPP: 79; NKF: 74	NKPP: 58 (73.1) vs NKF: 56 (75.67)	NKPP: 4 (5.06); NK: 5 (6.755)	NKPP: 2 (2.530); NKF: 2 (2.27)	NKPP: 6 (7.59); NKF: 0	1 death in NKPP-severe PEP
Catalano et al[7], 2004	Not defined	Not defined	63	N/A	N/A	TPS: 3; NKPP: 33	TPS: 29 (94) vs NKPP: 24 (75)	-	-	-	21 (61) had PD stents in NK group
Zhang et al[8], 2022			188; prospective cohort study based on papilla type			NKPP: 75; NKF: 113	NKPP: 68 (90.7) vs NK: 104 (92)	NKPP: 1 (1.3); NKF: 3 (2.6)	NKPP: 0; NKFF: 1 (1.3)	NKPP: 5 (6.65); NKF: 6 (5.3)	-
Tang et al[9], 2005	Failure to cannulate within 7 minutes by an endoscopy fellow or within 5 minutes by experienced endoscopist	Not defined	62	NKPP: 64.6 ± 13.3; RSG: 67.2 ± 12.7	NKPP: 15 (46.9); RSG: 14 (46.7)	NKPP: 32; RSG: 30	NKPP: 24 (75) vs RSG: 22 (73.3)	NKPP: 3 (12.5); RSG: 0	NKPP: 0; RSG: 0	NKPP: 0; RSG: 1 (4.5)	-
Zhou et al[10], 2006	Failed cannulation after 10 minutes or pancreatic duct entry > 3 times		91			NKPP: 43; RSG: 48	NKPP: 39 (90.7) vs RSG: 36 (75)	-	-	-	Complication rate; NKPP: 9.3; RSG: 14.6
Maharshi and Sharma[12], 2021	> 2 failed cannulation attempts	Experience > 25 years; > 1000 ERCP per year	303	NKPP: 47.5 ± 14.5; primary NKPP: 48.2 ± 15.4	NKPP: 126 (41.5); primary NKPP: 61 (40.1)	NKPP: 152; primary NKPP: 151	NKPP: 141 (92.7) vs primary NKPP: 140 (92.7)	NKPP: 3 (1.95); primary NKPP: 4 (2.6)	NKPP: 1 (0.66); primary NKPP: 1 (0.67)	NKPP: 8 (5.2); primary NKPP: 1 (0.67)

DBC: Difficult biliary cannulation; PD: Pancreatic duct; PEP: Post endoscopic retrograde cholangiopancreatography pancreatitis; NKPP: Needle knife precut papillotomy; NKF: Needle knife fistulotomy; NK: Needle knife; N/A: Not applicable; TPS: Trans-pancreatic sphincterotomy; RSG: Repeated single guidewire cannulation; ERCP: Endoscopic retrograde cholangiopancreatography.