Needle knife fstulotomy in flat and diverticular papillae:Is it time for redemption?  

作　　者：João Fernandes Jorge Canena Marta Moreira Gonçalo Alexandrino Luísa Figueiredo Tarcísio Araújo Luís Lourenço David Horta Luís Lopes 

机构地区：[1]Department of Gastroenterology,Santa Luzia Hospital-Unidade Local de Saúde Alto Minho,Viana do Castelo,Portugal [2]Department of Gastroenterology,Professor Doutor Fernando Fonseca Hospital,Amadora,Portugal [3]Department of Gastroenterology,Nova Medical School/Faculty of Medical Sciences,Lisbon,Portugal [4]University Center of Gastrenterology-Hospital Cuf Tejo,Lisbon,Portugal [5]Life and Health Sciences Research Institute(ICVS),School of Medicine,University of Minho,Braga,Portugal [6]ICVS/3B’s-PT Government Associate Laboratory,Braga/Guimarães,Portugal

出　　处：《Hepatobiliary & Pancreatic Diseases International》2022年第2期175-181,共7页国际肝胆胰疾病杂志（英文版）

摘　　要：Background: European Society of Gastrointestinal Endoscopy( ESGE) recommends needle-knife fstulotomy(NKF) as the preferred precut technique in cases when standard cannulation techniques fail. Despite scarce scientifc evidence, flat and diverticular papillae are thought not to be ideal for NKF, as they are associated with poor outcomes. The present study aimed to determine the outcomes of the use of NKF in relation to flat and intradiverticular papillae. Methods: This prospective multicenter study enrolled consecutive patients, evidencing na?ve flat(group A, n = 49) or diverticular papilla(group B, n = 28), who underwent NKF after failure of standard cannulation techniques. Diverticular morphology was subdivided into intradiverticular(group B1, n = 14) and diverticular border papillae(group B2, n = 14), using a previously validated endoscopic classifcation of the major papilla. The success of biliary cannulation at initial endoscopic retrograde cholangiopancreatography(ERCP), overall biliary cannulation, overall cannulation time, and the rate of adverse events were assessed in the study. Results: The initial cannulation rates were 93.9%, 64.3% and 71.4% for group A, B1, and B2, respectively( P = 0.005);overall cannulation rates after a second ERCP were 98.0%, 92.9% and 85.7%, respectively( P = 0.134). Adverse events occurred in 11.7% of patients, with post-ERCP pancreatitis(PEP) being the most common adverse event(10.4%). Although there was a trend towards a higher incidence of PEP in flat papillae, univariate and multivariate analyses did not show any signifcant relationship between pancreatitis and trainee involvement, papillary morphology, nor overall cannulation time. Conclusions: Although flat papillae are associated with high success rates of biliary cannulation using NKF, the rate of PEP is not negligible. NKF is feasible in diverticular papillae, but it is associated with a modest success rate in the initial ERCP.

关 键 词：Endoscopic retrograde cholangiopancreatography Needle-knife fstulotomy Small papilla Diverticular papilla COMPLICATIONS 

分 类 号：R657.5[医药卫生—外科学]