Original Article
Copyright ©2012 Baishideng. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2012; 4(9): 398-404
Published online Sep 16, 2012. doi: 10.4253/wjge.v4.i9.398
Comparison between needle-knife fistulotomy and standard cannulation in ERCP
Mohammad Ayoubi, Giovanni Sansoè, Nicola Leone, Francesca Castellino
Mohammad Ayoubi, Nicola Leone, Francesca Castellino, Gianni Sansoè, Endoscopy unit, Gradenigo Hospital, 10153 Torino, Italy
Author contributions: Ayoubi M performed all the Endoscopic procedures and contributed to the writing of article; Sansoè G contributed to the writing of the article and statistical analysis; Castellino F and Leone N followed patients in the days after ERCP to record any post ERCP complication.
Correspondence to: Mohammad Ayoubi, MD, Head, Endoscopy Unit, Gradenigo Hospital, Corso Regina Margherita 10, 10153 Torino, Italy. ayoubi@libero.it
Telephone: +39-11-8151500 Fax: +39-11-8151253
Received: February 1, 2012
Revised: July 2, 2012
Accepted: September 12, 2012
Published online: September 16, 2012
Abstract

AIM: To compare the rates of success and complications of two different methods of access into the common bile duct (CBD).

METHODS: Between October 2007 and November 2008, 173 consecutive patients (71 men, 102 women, mean age 68.6 years) requiring endoscopic retrograde cannulation of the papilla and endoscopic treatment were studied. In the first 88 patients CBD cannulation was performed through supra-papillary fistulotomy (group F); in the following 85 patients standard cannulation was performed through the Oddi sphincter (group S). Indications for the procedure were: choledocholithiasis, biliary obstruction, postoperative leak, sclerosing cholangitis, and Mirizzi’s syndrome.

RESULTS: Deep CBD cannulation was successful in 85/88 patients (96.5%) in group F vs 60/85 patients (70.6%) in group S (P < 0.0001). The remaining 25 group S patients in whom cannulation failed were shifted to fistulotomy. Fistulotomy was successful in 21/25 patients (84%). As for complications, hyperamilasemia occurred in 7 (7.9%) group F patients vs 7 (8.2%) group S patients (P = NS); mild pancreatitis in 1 (1.1%) group F patient vs 5 (5.8%) group S patients (P = NS); bleeding in 3 (3.4%) group F patients vs 3 (3.5%) group S patients (P = NS).

CONCLUSION: Needle-knife fistulotomy should represent either the first approach to therapeutic cannulation or rescue therapy after unsuccessful standard cannulation.

Keywords: Common bile duct; Fistulotomy; Papillotomy; Biliary stones; Pancreatitis