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. 2022 Mar 23;12(1):4942.
doi: 10.1038/s41598-022-09117-9.

Predictive factors of needle-knife pre-cut papillotomy failure in patients with difficult biliary cannulation

Mu-Hsien Lee  1 , Shu-Wei Huang  1 , Cheng-Hui Lin  1 , Yung-Kuan Tsou  2 , Kai-Feng Sung  1 , Chi-Huan Wu  1 , Nai-Jen Liu  1
Affiliations

Predictive factors of needle-knife pre-cut papillotomy failure in patients with difficult biliary cannulation

Mu-Hsien Lee et al. Sci Rep. .

Abstract

Predictors of needle-knife pre-cut papillotomy (NKP) failure for patients with difficult biliary cannulation has not been reported. Between 2004 and 2016, 390 patients with difficult biliary cannulation undergoing NKP were included in this single-center study. Following NKP, deep biliary cannulation failed in 95 patients (24.4%, NKP-failure group) and succeeded in 295 patients (75.6%, NKP-success group). Patient and technique factors were used to identify the predictors of initial NKP failure. Compared with the NKP-success group, periampullary diverticulum (28.4% vs. 18%, p = 0.028), surgically altered anatomy (13.7% vs. 7.1%, p = 0.049), number of cases performed by less experienced endoscopists, and bleeding during NKP (38.9% vs. 3.4%, p < 0.001), were significantly more frequent in the NKP-failure group. On multivariate analysis, surgically altered anatomy (OR 2.374, p = 0.045), endoscopists' experience (OR 3.593, p = 0.001), and bleeding during NKP (OR 21.18, p < 0.001) were significantly associated with initial failure of NKP. In conclusion, NKP is a highly technique-sensitive procedure, as endoscopists' experience, bleeding during NKP, and surgically altered anatomy were predictors of initial NKP failure.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Needle-knife pre-cut papillotomy. (a) Original major papilla. (b) The incision is made upward along the axis of the bile duct from the papillary orifice. (c) The overlying mucosa is incised, and the bile duct is exposed. (d) Successful biliary cannulation is achieved.
Figure 2
Figure 2
Bleeding during needle-knife pre-cut papillotomy could result in failure of the procedure.
See this image and copyright information in PMC

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