Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography

作     者：Ping-Hong Zhou, Li-Qing Yao, Mei-Dong Xu, Yun-Shi Zhong, Wei-Dong Gao, Guo-Jie He, Yi-Qun Zhang, Wei-Feng Chen and Xin-Yu Qin Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China 

作者机构：Department of General Surgery Zhongshan Hospital Fudan University Shanghai 200032 China. chow@*** 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2006年第5卷第4期

页      面：590-594页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：endoscopic retrograde cholangiopancreatography needle-knife cannulation 

摘      要：BACKGROUND: Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10% of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or fistulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups. RESULTS: A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with difficult biliary cannulation, 43 patients underwent needle-knife cut: the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques: the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Significant differences were observed in cannulation success rate and cannulation time but in complication rate between the two ***: The early application of the needle-knife in difficult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.