Clinical Medicine Insights: Gastroenterology

Aims: To evaluate the safety, effectiveness, success rate and complications of needle knife precut papillotomy for inaccessible bile duct after failed pancreatic ducts access.

Methods: Selective common bile duct cannulation was required for 582 patients from November 2004 to May 2008. Precut sphincterotomy was performed in 28 patients (16 male, 12 female; mean age 71). When standard bile duct cannulation was unsuccessful after more than 20 minutes, the bile duct was considered inaccessible. Group A consisted of patients where pancreatic duct access was possible and transpancreatic papillary septotomy was performed (20 patients). If pancreatic duct cannulation also failed, needle knife precut method was performed and these patients belonged to group B (8 patients). The success and complication rates of the two groups were compared using the Chi-square test.

Results: The success rates were 85% and 87.5% respectively. Of the 28 patients in group A, 6 had mild to moderate pancreatitis and one patient had mild bleeding. The complication rates were 35% and 0% respectively and the differences were not significant.

Conclusion: Needle knife precut papillotomy is useful and acceptable in patients after failed pancreatic duct access.