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• W2025378683 abstract "Two generations of ERCP endoscopists have been indoctrinated into thinking that needle-knife papillotomy (NKP) is a dangerous procedure that should only be performed by experts. A report from Denmark looking at severe and fatal adverse events of ERCP resulting in litigation between 1992 and 1996 concluded that NKP “should still be regarded as a dangerous procedure.” 1 Trap R. Adamsen S. Hart-Hansen O. et al. Severe and fatal complications after diagnostic and therapeutic ERCP: a prospective series of claims to insurance covering public hospitals. Endoscopy. 1999; 31: 125-130 Crossref PubMed Scopus (102) Google Scholar Early published studies typically reported adverse event rates of NKP that were often double that of standard biliary sphincterotomy. A recent retrospective review of prospectively collected data on NKP continued to show a high post-ERCP pancreatitis (PEP) rate. 2 Katsinelos P. Gkagkalis S. Chatzimavoudis G. et al. Comparison of three types of precut technique to achieve common bile duct cannulations: a retrospective analysis on 274 cases. Dig Dis Sci. 2012; 57: 3286-3292 Crossref PubMed Scopus (64) Google Scholar However, in some expert hands, NKP apparently could be performed without excess morbidity from the beginning. 3 Rabenstein T. Ruppert T. Schneider H.T. et al. Benefits and risks of needle knife papillotomy. Gastrointest Endosc. 1997; 46: 207-211 Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar In a recent study from Australia 4 Bailey A.A. Bourke M.J. Kaffes A.J. et al. Needle-knife sphincterotomy: factors predicting its use and the relationship with post-ERCP pancreatitis (with video). Gastrointest Endosc. 2010; 71: 266-271 Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar of 732 cases, 94 of which were deemed difficult, NKP increased the overall biliary cannulation rate to 97.7% at the cost of a 14.9% PEP rate. Statistical analysis revealed that the independent risk factor for PEP was not NKP, but rather the number of cannulation attempts, confirming what Freeman 5 Freeman M.L. Understanding risk factors and avoiding complications with endoscopic retrograde cholangiopancreatography. Curr Gastroenterol Rep. 2003; 5: 145-155 Crossref PubMed Scopus (60) Google Scholar has been telling us for years: NKP used to finish the job gets blamed unfairly for PEP after the duodenal papilla is traumatized during failed cannulation attempts. Another confounding factor as one tries to follow the literature on NKP is the ever-changing ERCP landscape: when Vandervoort et al 6 Vandervoort J. Soetikno R.M. Tham T.C. et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc. 2002; 56: 652-656 Abstract Full Text Full Text PDF PubMed Scopus (487) Google Scholar reported their study of adverse events of 1223 ERCPs in 2002, 45% were diagnostic and 55% were therapeutic. A 2006 prospective, multicenter study of risk factors for PEP included 48% diagnostic and 52% therapeutic cases, with an amazing 34% undergoing ERCP for suspected sphincter of Oddi dysfunction. 7 Cheng C.L. Sherman S. Watkins J.L. et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Am J Gastroenterol. 2006; 101: 139-147 Crossref PubMed Scopus (496) Google Scholar Today, it is difficult to find a purely diagnostic indication for ERCP, and the frequent use of sphincter of Oddi manometry is limited to a few academic centers, mainly in the United States." @default.
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• W2025378683 title "Reflections on needle-knife papillotomy (with videos)" @default.
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