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Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

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Abstract

Background

Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors.

Methods

Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP.

Results

For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34–3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52–15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55–22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21– 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis.

Conclusions

Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Naoko Kurihara, Yuko Okamoto, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada & Kohsaku Sakaguchi

  2. Department of Gastroenterology, Okayama Saiseikai General Hospital, Okayama, Japan

    Hironari Kato & Osamu Mizuno

  3. Department of Gastroenterology, Kurashiki Central Hospital, Okayama, Japan

    Ken Hirao & Takashi Nakanishi

Authors
  1. Hirotoshi Fukatsu
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  2. Hirofumi Kawamoto
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  3. Hironari Kato
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  4. Ken Hirao
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  5. Naoko Kurihara
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  8. Yuko Okamoto
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  9. Tsuneyoshi Ogawa
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  11. Hiroyuki Okada
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  12. Kohsaku Sakaguchi
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Correspondence to Hirofumi Kawamoto.

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Fukatsu, H., Kawamoto, H., Kato, H. et al. Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. Surg Endosc 22, 717–723 (2008). https://doi.org/10.1007/s00464-007-9473-8

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  • DOI: https://doi.org/10.1007/s00464-007-9473-8

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