Efficacy and safety of primary, early and late needle-knife fistulotomy for biliary access.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
17 08 2021
17 08 2021
Historique:
received:
15
07
2020
accepted:
02
08
2021
entrez:
18
8
2021
pubmed:
19
8
2021
medline:
11
11
2021
Statut:
epublish
Résumé
European Society of Gastrointestinal Endoscopy recommends needle-knife fistulotomy (NKF) as the preferred precut technique. However, there is little information on whether NKF performed at different times is associated with different success and adverse event rates. We compared the outcomes of 3 different timings of NKF. This was an observational study conducted at 4 institutions and this was a retrospective analysis of prospectively collected data. We included 330 consecutive patients submitted to NKF attempt for biliary access. Patients were divided into three groups: NKF as an initial procedure for biliary access (group A, n = 121); early NKF defined as after 5 min, 5 attempts, or 2 pancreatic passages (group B, n = 99); and late NKF: after at least 10 min of unsuccessful standard biliary cannulation (group C, n = 110). We assessed the success rate of biliary cannulation at initial ERCP, time to perform NKF until biliary cannulation, overall biliary cannulation rate (second ERCP when initial failure), adverse event rate, and predictors of post-ERCP pancreatitis (PEP). The initial cannulation rate was 98%, 91% and 94% for groups A, B and C respectively, p = 0.08, whereas overall biliary cannulation rate was 100%, 95% and 98%, p = 0.115. The adverse event rate/PEP was 4.1%/2.5%, 7.1%/4% and 10.9%/8.2%, for groups A, B and C respectively, (p = 0.197 and p = 0.190). Median time for creating the fistula was A = 4.0 min, B = 3.2 min, and C = 5.6 min, p < 000.1. Each additional minute spent attempting cannulation increased the odds ratio (OR) for PEP by 1.072, and patients with 3 or more risk factors for pancreatitis had a higher chance of PEP. In conclusion, the timing of NFK does not appear to influence success rates but late NFK is associated with a higher time to create a fistula and an increased risk of pancreatitis. Primary NFK is associated with a high rate of success and a low rate of PEP and deserves additional investigation.
Identifiants
pubmed: 34404873
doi: 10.1038/s41598-021-96142-9
pii: 10.1038/s41598-021-96142-9
pmc: PMC8371017
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
16658Informations de copyright
© 2021. The Author(s).
Références
World J Gastroenterol. 2014 Apr 14;20(14):4093-101
pubmed: 24744601
Gastrointest Endosc. 1997 Sep;46(3):207-11
pubmed: 9378205
Gastrointest Endosc. 2010 Mar;71(3):446-54
pubmed: 20189503
Gastrointest Endosc. 2017 Jan;85(1):32-47
pubmed: 27546389
N Engl J Med. 2012 Apr 12;366(15):1414-22
pubmed: 22494121
Endoscopy. 1978 Aug;10(3):203-6
pubmed: 699889
Gastrointest Endosc. 1991 May-Jun;37(3):383-93
pubmed: 2070995
Dig Dis Sci. 2012 Dec;57(12):3286-92
pubmed: 22714730
Gastrointest Endosc. 2015 Jul;82(1):70-8
pubmed: 25771064
Am J Gastroenterol. 2002 Jul;97(7):1708-12
pubmed: 12135022
Gastrointest Endosc. 2016 Nov;84(5):808-813
pubmed: 27102829
Gastrointest Endosc. 2001 Oct;54(4):425-34
pubmed: 11577302
Gastrointest Endosc. 1996 Jul;44(1):48-53
pubmed: 8836716
Clin Gastroenterol Hepatol. 2007 Sep;5(9):1113-8
pubmed: 17689295
GE Port J Gastroenterol. 2019 Mar;26(2):105-113
pubmed: 30976615
Endoscopy. 2014 Sep;46(9):799-815
pubmed: 25148137
Surg Endosc. 2010 Aug;24(8):1937-40
pubmed: 20135176
Dig Dis Sci. 2014 Nov;59(11):2779-89
pubmed: 24821464
Am J Gastroenterol. 2009 Jan;104(1):31-40
pubmed: 19098846
Gastrointest Endosc. 2010 May;71(6):934-9, 939.e1-2
pubmed: 20226455
J Clin Gastroenterol. 2005 Sep;39(8):717-21
pubmed: 16082283
Arch Iran Med. 2008 Jan;11(1):16-20
pubmed: 18154417
GE Port J Gastroenterol. 2018 Jan;25(1):6-9
pubmed: 29457044
Am J Gastroenterol. 2020 Apr;115(4):616-624
pubmed: 31913191
Scand J Gastroenterol. 2014 Jun;49(6):759-65
pubmed: 24641260
Am J Gastroenterol. 2020 Apr;115(4):535-536
pubmed: 32049681
Am J Gastroenterol. 2009 Oct;104(10):2412-7
pubmed: 19550413
N Engl J Med. 1996 Sep 26;335(13):909-18
pubmed: 8782497
Endoscopy. 2016 Jul;48(7):657-83
pubmed: 27299638
Gastrointest Endosc. 1999 Sep;50(3):334-9
pubmed: 10462652
Gastrointest Endosc. 2014 Oct;80(4):634-641
pubmed: 24814775
Dig Dis Sci. 2011 Jun;56(6):1896-903
pubmed: 21082346
Gastrointest Endosc. 2014 Feb;79(2):279-88
pubmed: 24012251