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Cannulation procedure optimization for patients with duodenal papillary tumors

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Abstract

Background

The goal of this study was to compare the efficacy and safety of needle-knife fistulotomy (NKF) to that of conventional cannulation methods (CCMs) when used for primary biliary access in patients with duodenal papillary tumors.

Methods

Consecutive patients who had duodenal papillary tumors and who underwent endoscopic retrograde cholangiopancreatography (ERCP) were retrospectively enrolled. Successful cannulation rates, cannulation and procedure times, and the prevalence of adverse events were compared between the NKF and CCM groups.

Results

A total of 404 patients (NKF, n = 124; CCM, n = 280) with duodenal papillary tumors were included. The primary and overall cannulation rates were 92.1% (372/404) and 96.0% (388/404), respectively. Compared to CCMs, NKF was associated with a significantly higher successful cannulation rate (99.2% versus 88.9%, P < 0.001) and significantly lower cannulation times (2.1 ± 2.0 min versus 4.7 ± 5.2 min), procedure times (8.8 ± 3.8 min versus 12.9 ± 7.6 min), and unintentional pancreatic duct cannulation rates (1.6% versus 20%), with P < 0.001 for all. Overall adverse events occurred less frequently in the NKF group (3.2% versus 10.7%, P = 0.011). Of these adverse events, post-ERCP pancreatitis (PEP) was significantly lower in the NKF group than in the CCM group (1.6% versus 6.8%, P = 0.03). Bleeding and cholangitis rarely occurred with either cannulation method (0.8% versus 2.1%, P = 0.681, and 0.8% versus 1.7%, P = 0.671, respectively).

Conclusion

NKF is a more effective and safer procedure than CCMs for patients with duodenal papillary tumors.

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Abbreviations

CCM:

Conventional cannulation methods

NKF:

Needle-knife fistulotomy

ERCP:

Endoscopic retrograde cholangiopancreatography

EST:

Endoscopic sphincterotomy

ERPD:

Endoscopic retrograde pancreatic drainage

ENBD:

Endoscopic nosalbiliary drainage

ERBD:

Endoscopic retrograde biliary drainage

PEP:

Post-ERCP pancreatitis

ESGE:

European Society of Gastrointestinal Endoscopy

INR:

International normalized ratio

CA199:

Carbohydrate antigen 199

TBil:

Total bilirubin

DBil:

Direct bilirubin

GGT:

Glutamate transpeptidase

AKP:

Alkaline phosphatase

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Acknowledgements

We are sincerely grateful to the medical staff in our endoscopy unit for their collaboration on this work. The authors also acknowledge American Journal Experts (Durham, NC, USA) for assisting in the preparation of the manuscript.

Funding

National Natural Science Foundation of China (81760106) and the Doctoral Scientific Research Foundation of The First Affiliated Hospital of Nanchang University (No. 700648002).

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Correspondence to Youxiang Chen.

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Disclosures

Junbo Hong, Honogtao Zhu, Wei Zuo, Liang Zhu, Xiaodong Zhou, Xiaojiang Zhou, Guohua Li, Zhijian Liu, Pi Liu, Hao Zhen, Yong Zhu, Anjiang Wang, Jiuhong Ma, Jianhui Yuan, Xu Shu, Yin Zhu, Nonghua Lu and Youxiang Chen have no conflicts of interest or financial ties to disclose.

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Hong, J., Zhu, H., Zuo, W. et al. Cannulation procedure optimization for patients with duodenal papillary tumors. Surg Endosc 35, 5635–5642 (2021). https://doi.org/10.1007/s00464-020-08076-4

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