Incidence of Needle Knife Precut Sphincterotomy in a Sample of Patients Attending Gastroenterology and Hepatology Teaching Hospital in Baghdad
Keywords:
sphincterotomy, cholangiocarcinoma, CholedocholithiasisAbstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been a remarkable technological advance has redefined the medical and surgical approach to patients with pancreatic and biliary tract diseases.
Selective deep cannulation of the common bile duct (CBD) or pancreatic duct is the most important step for successful therapeutic endoscopic retrograde cholangiopancreatography (ERCP). Successful cannulation rates of more than 85% are achievable by most practising endoscopists.
despite technical innovations, improved endoscopic imaging, and specialized accessories, deep biliary cannulation still fail in (5% to 15%) of cases, even in experienced centers. In these situations the use of alternative techniques may be necessary.
Needle-knife papillotomy technique used during endoscopic retrograde cholangiopancreatography (ERCP) to facilitate access to the common bile duct or pancreatic duct (PD) when Standard cannulation techniques have failed.
Aim of the Study: Evaluation of patients seeking gastroenterology and hepatology teaching hospital / medical city / Baghdad, about the incidence of needle knife precut sphinctrotomy and whether agreed with the percent of needle knife precut sphinctrotomy of other centers in the world or not.
Patients and Methods: The study was a hospital based cross sectional descriptive analytic study conducted in the gastroenterology and hepatology teaching hospital / Medical City / Baghdad / Iraq during a period from November 2022 to November 2023 ,about (350) patients for endoscopic retrograde pancreatocholangiography(ERCP) examinations for different causes.
When standard biliary duct cannulation was unsuccessful and the bile duct was deemed inaccessible,The endoscopist was then permitted to use the precut method by needle knife .
Results: From 1030 patients were involved in our study , about 111 patients underwent needle knife (precut) Sphincterotomy in a percent (10.7%) , the causes for needle knife sphictrotomy was: Choledocholithiasis in 62 patients (55.8%) ; pancreatic cancer in 24 patients (21.6%) suspected cholangiocarcinoma 16 patients (14.4%) other causes ( ampullary tumor (3 patients), bile duct injury (2 patients) and diverticulum effect (1 patients) .
The patient had different age groups ; ( about 43.2% were at middle age (46-65 years), followed by the elderly group (40%), while the young age group constitute the minor proportion (only 20.7%)) and in both sexes , our patients were 55 male patients(49.5%) and 56 female patients( 50.5%).
Conclusion: The results of our study are comparable to incidence of needle knife precut sphincterotomy reported by high-volume tertiary referral centers and suggest that such a strategy can be safe and effective in trained and experienced hands.
References
1. Paul Kortan and Gary May :Access( precut ) papillotomy. InERCP 2013 ,second edition, 2013 :14:116-123. Elsevier
2. Siegel JH. Precut papillotomy: a method to improve the success of ERCP and papillotomy. Endoscopy. 1980;12:130-133.
3. De Weerth A, Seitz U, Zhong Y, Groth S, Omar S, Papageorgiou C, Bohnacker S, Seewald S, Seifert H, Binmoeller KF, Thonke F. Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy. 2006 Dec;38(12):1235-40.
4. Ang TL, Kwek AB, Lim KB, Teo EK, Fock KM. An analysis of the efficacy and safety of a strategy of early precut for biliary access during difficult endoscopic retrograde cholangiopancreatography in a general hospital. Journal of digestive diseases. 2010 Oct;11(5):306
5. Carr-Locke DL. Biliary access during endoscopic retrograde cholangiopancreatography. Can .J Gastroenterol. 2004;18:251–254
6. Freeman ML. Precut (access) sphincterotomy. Techniques in Gastrointestinal Endoscopy. 1999 Jan 1;1(1):40-8.Freeman ML. Precut (access) sphincterotomy.Techniques in Gastrointestinal Endoscopy. 1999 Jan 1;1(1):40-8.
7. Mammen A, Haber G. Difficult biliary access: advanced cannulation and sphincterotomy technique. Gastrointestinal Endoscopy Clinics. 2015 Oct 1;25(4):619-30.
8. Sriram PV, Rao GV, Reddy DN. The precut–when, where and how? A review. Endoscopy. 2003 Aug;35(08):S24-30.
9. Rochester JS, Jaffe DL. Minimizing complications in endoscopic retrograde cholangiopancreatography and sphincterotomy. Gastrointest Endosc Clin N Am. 2007;17:105–127, vii.
10. Park SH, Kim HJ, Park DH, Kim JH, Lee JH, Lee SH, Chung IK, Kim HS,Kim SJ. Pre-cut papillotomy with a new papillotome. Gastrointestinal endoscopy. 2005 Oct 1;62(4):588-91.
11. Binmoeller KF, Seifert H, Gerke H, Seitz U, Portis M, Soehendra N. Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation. Gastrointestinal endoscopy. 1996 Dec 1;44(6):689-95.
12. Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointestinal endoscopy. 1995 May 1;41(5):502-5.
13. Goff JS. Long-term experience with the transpancreatic sphincter pre-cut approach to biliary sphincterotomy. Gastrointestinal endoscopy. 1999 Nov1;50(5):642-5.
14. Akashi R, Kiyozumi T, Jinnouchi K, Yoshida M, Adachi Y, Sagara K. Pancreatic sphincter precutting to gain selective access to the common bile duct: a series of 172 patients. Endoscopy. 2004 May;36(05):405-10.
15. Weber A, Roesch T, Pointner S, Born P, Neu B, Meining A, Schmid RM, Prinz C. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: a safe and successful technique. Pancreas. 2008 Mar 1;36(2):187-91.
16. Burdick JS, London A, Thompson DR. Intramural incision technique. Gastrointestinal endoscopy. 2002 Mar 1;55(3):425-7.
17. Misra SP, Dwivedi M. Intramural incision technique: a useful and safe procedure for obtaining ductal access during ERCP. Gastrointestinal endoscopy. 2008 Apr 1;67(4):629-33..
18. Shakoor T, Geenen JE. Pre-cut papillotomy. Gastrointest Endosc.1992;38:623–7.
19. Rabenstein T, Ruppert T, Schneider HT, Hahn EG, Ell C. Benefits and risks of needle-knife papillotomy. Gastrointestinal endoscopy. 1997 Sep 1;46(3):207-11.
20. Cotton PB. Needleknife precut sphincterotomy: the devil is in the indications. Endoscopy. 1997 Nov;29(9):888.
21. Dhir V, Mallath MK. Is pre-cut papillotomy guilty as accused?. Gastrointestinal endoscopy. 1999 Jul 1;50(1):143-4.
22. Cotton PB. Precut papillotomy--a risky technique for experts only. Gastrointestinal Endoscopy. 1989;35(6):578.
23. BORGES AC, ALMEIDA PC, FURLANI SM, CURY MD, PLESKOW DK.ERCP performance in a tertiary Brazilian Center: Focus on new risk factors complications and quality indicators. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 2018;31(1).
24. Dumonceau JM, Andriulli A, Devière J, Mariani A, Rigaux J, Baron TH, Testoni PA. European Society of Gastrointestinal Endoscopy (ESGE) Guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy. 2010 Jun;42(06):503-15.
25. Testoni PA. Why the incidence of post-ERCP pancreatitis varies considerably? Factors affecting the diagnosis and the incidence of this complication. Jop. 2002 Nov;3(6):195-201.
26. Lawrence C, Romagnuolo J, Cotton PB, Payne KM, Hawes RH. Post-ERCP pancreatitis rates do not differ between needle-knife and pull-type pancreatic sphincterotomy techniques: a multiendoscopist 13-year experience. Gastrointestinal endoscopy. 2009 Jun 1;69(7):1271-5.
27. Slot WB, Schoeman MN, Disario JA, Wolters F, Tytgat GN, Huibregtse K. Needle-knife sphincterotomy as a precut procedure: a retrospective evaluation of efficacy and complications. Endoscopy. 1996 May;28(04):334-9.
28. Rollhauser C, Johnson M, Al-Kawas FH. Needle-knife papillotomy: a helpful and safe adjunct to endoscopic retrograde cholangiopancreatography in a selected population. Endoscopy. 1998 Oct;30(08):691-6.
29. Dowsett JF, Polydorou AA, Vaira D, D'Anna LM, Ashraf M, Croker J, Salmon PR, Russell RC, Hatfield AR. Needle knife papillotomy: how safe and how effective?. Gut. 1990 Aug 1;31(8):905-8.
30. Miyatani H, Yoshida Y. Endoscopic needle knife precut papillotomy for inaccessible bile duct following failed pancreatic duct access. Clinical Medicine. Gastroenterology. 2009 Jan;2:CGast-S1120.
