Incidence of Needle Knife Precut Sphincterotomy in a Sample of Patients Attending Gastroenterology and Hepatology Teaching Hospital in Baghdad

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.