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Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy

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Abstract

Background

Although needle-knife precut papillotomy (NKPP) is considered a useful alternative for achieving selective biliary cannulation, controversy remains regarding the technical proficiency needed to perform the procedure and its safety. This study evaluated whether procedural experience with NKPP predicted either successful cannulation or the development of complications.

Methods

This study retrospectively investigated 104 patients, out of 589 consecutive patients with native papillary, who underwent NKPP performed by a single endoscopist between October 2002 and July 2006. To demonstrate changes in NKPP, the 104 patients were divided chronologically into two groups according to periods: period A (October 2002 to September 2004) and period B (October 2004 to July 2006).

Results

Of the 104 consecutive patients who underwent NKPP, 41 (41/267, 15%) were treated in period A and 63 (63/322, 20%) in period B. There was no significant difference in the overall success rate between periods A (90%) and B (98%) (p = 0.08). However, the initial success rate was higher in period B (95%) than in period A (80%) (p < 0.05). The complication rates were not significantly different between the two groups (10% vs 16%; p = 0.56). Although all complications involved pancreatitis, severe pancreatitis was not observed.

Conclusion

Whereas the initial success rate for NKPP can increase with procedural experience, the complication rate does not seem to decrease. Furthermore, the need for NKPP does not appear to decrease with increasing endoscopic retrograde cholangiopancreatography (ERCP) experience.

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Acknowledgments

The authors thank N. Fukatsu for her help in the redaction of this article.

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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, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Takashi Nakanishi, Osamu Mizuno, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada & Kohsaku Sakaguchi

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

    Hironari Kato

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

    Ken Hirao

Authors
  1. Hirotoshi Fukatsu
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  2. Hirofumi Kawamoto
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  3. Ryo Harada
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  4. Koichiro Tsutsumi
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  5. Masakuni Fujii
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  6. Hironari Kato
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  7. Ken Hirao
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  8. Takashi Nakanishi
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  9. Osamu Mizuno
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  12. Hiroyuki Okada
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  13. Kohsaku Sakaguchi
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Correspondence to Hirofumi Kawamoto.

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Fukatsu, H., Kawamoto, H., Harada, R. et al. Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy. Surg Endosc 23, 2066–2072 (2009). https://doi.org/10.1007/s00464-008-9969-x

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  • DOI: https://doi.org/10.1007/s00464-008-9969-x

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