Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

Hirotoshi Fukatsu, Hirofumi Kawamoto, Hironari Katou, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Yuko Okamoto, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kohsaku Sakaguchi

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors. Methods: Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP. Results: For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34-3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52-15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55-22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21- 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis. Conclusions: Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

Original languageEnglish
Pages (from-to)717-723
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume22
Issue number3
DOIs
Publication statusPublished - Mar 2008

Fingerprint

Catheterization
Needles
Odds Ratio
Confidence Intervals
Gastroenterostomy
Endoscopic Retrograde Cholangiopancreatography
Hepatectomy
Gastrectomy
Pancreatitis
Hypertrophy
Pathologic Constriction
Multivariate Analysis

Keywords

  • Biliary cannulation
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Needle-knife precut papillotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. / Fukatsu, Hirotoshi; Kawamoto, Hirofumi; Katou, Hironari; Hirao, Ken; Kurihara, Naoko; Nakanishi, Takashi; Mizuno, Osamu; Okamoto, Yuko; Ogawa, Tsuneyoshi; Ishida, Etsuji; Okada, Hiroyuki; Sakaguchi, Kohsaku.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 22, No. 3, 03.2008, p. 717-723.

Research output: Contribution to journalArticle

Fukatsu, Hirotoshi ; Kawamoto, Hirofumi ; Katou, Hironari ; Hirao, Ken ; Kurihara, Naoko ; Nakanishi, Takashi ; Mizuno, Osamu ; Okamoto, Yuko ; Ogawa, Tsuneyoshi ; Ishida, Etsuji ; Okada, Hiroyuki ; Sakaguchi, Kohsaku. / Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors. In: Surgical Endoscopy and Other Interventional Techniques. 2008 ; Vol. 22, No. 3. pp. 717-723.
@article{bc2458d62e834ff2a04b03e4b2b751a9,
title = "Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors",
abstract = "Background: Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors. Methods: Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16{\%}). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84{\%}) and those who underwent NKPP. Results: For 76 difficult cannulation cases (95{\%}), successful cannulation after NKPP was accomplished, and the total success rate reached 99{\%} (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95{\%} confidence interval [CI], 1.34-3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95{\%} CI, 2.52-15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95{\%} CI, 2.55-22.02), and malignant biliary stricture (OR, 2.31; 95{\%} CI, 1.21- 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11{\%}), all of which were pancreatitis. Conclusions: Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.",
keywords = "Biliary cannulation, Endoscopic retrograde cholangiopancreatography (ERCP), Needle-knife precut papillotomy",
author = "Hirotoshi Fukatsu and Hirofumi Kawamoto and Hironari Katou and Ken Hirao and Naoko Kurihara and Takashi Nakanishi and Osamu Mizuno and Yuko Okamoto and Tsuneyoshi Ogawa and Etsuji Ishida and Hiroyuki Okada and Kohsaku Sakaguchi",
year = "2008",
month = "3",
doi = "10.1007/s00464-007-9473-8",
language = "English",
volume = "22",
pages = "717--723",
journal = "Surgical Endoscopy",
issn = "0930-2794",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors

AU - Fukatsu, Hirotoshi

AU - Kawamoto, Hirofumi

AU - Katou, Hironari

AU - Hirao, Ken

AU - Kurihara, Naoko

AU - Nakanishi, Takashi

AU - Mizuno, Osamu

AU - Okamoto, Yuko

AU - Ogawa, Tsuneyoshi

AU - Ishida, Etsuji

AU - Okada, Hiroyuki

AU - Sakaguchi, Kohsaku

PY - 2008/3

Y1 - 2008/3

N2 - Background: Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors. Methods: Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP. Results: For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34-3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52-15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55-22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21- 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis. Conclusions: Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

AB - Background: Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors. Methods: Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP. Results: For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34-3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52-15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55-22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21- 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis. Conclusions: Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

KW - Biliary cannulation

KW - Endoscopic retrograde cholangiopancreatography (ERCP)

KW - Needle-knife precut papillotomy

UR - http://www.scopus.com/inward/record.url?scp=40349098503&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40349098503&partnerID=8YFLogxK

U2 - 10.1007/s00464-007-9473-8

DO - 10.1007/s00464-007-9473-8

M3 - Article

C2 - 17704885

AN - SCOPUS:40349098503

VL - 22

SP - 717

EP - 723

JO - Surgical Endoscopy

JF - Surgical Endoscopy

SN - 0930-2794

IS - 3

ER -