Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5950-5960
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5950
Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla
Wei Wang, Biao Gong, Wei-Song Jiang, Lei Liu, Kouken Bielike, Bin Xv, Yun-Lin Wu
Wei Wang, Yun-Lin Wu, Department of Gastroenterology, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai 201801, China
Biao Gong, Lei Liu, Kouken Bielike, Bin Xv, Department of Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Wei-Song Jiang, Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Author contributions: All authors contributed to this manuscript.
Open-Access: 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/
Correspondence to: Biao Gong, MD, Department of Digestive Endoscopy Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Road II, Shanghai 200025, China. gbercp@163.com
Telephone: +86-18801800616 Fax: +21-64370045-600918
Received: October 13, 2014
Peer-review started: October 14, 2014
First decision: December 11, 2014
Revised: February 1, 2015
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: May 21, 2015
Abstract

AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife.

METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed.

RESULTS: Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301).

CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.

Keywords: Needle-knife, Minor papilla, Cannulation, Meticulous procedure, Endoscopic retrograde cholangiopancreatography

Core tip: Cannulation of the minor papilla into the duct of Santorini can be difficult to achieve via standard procedures because of the tiny minor papilla orifice. Although various methods have been advocated to facilitate cannulation, some procedures still fail. The needle-knife has a slim tip, which is a unique advantage for insertion into the minor papilla orifice. After failure of standard cannulation techniques, we used three needle-knife procedures to facilitate cannulation via the minor papilla, which significantly improved the success rates of cannulation. In this series, we describe the meticulous procedures involved in this technique.