Early 'shallow' needle-knife papillotomy and guidewire cannulation: an effective and safe approach to XXXX .

@entity1 @entity788 @entity1829 @entity548
INTRODUCTION: Needle-knife sphincterotomy (NKS), known as 'precut', is used worldwide to facilitate access to the common bile duct when standard cannulation has failed. This procedure is considered hazardous because it is burdened with high procedural related complications ( @entity548 and perforation). Its right timing is still debated. In this study we report our results using a modified precut approach, early shallow needle-knife papillotomy (eSNKP) coupled with guidewire cannulation in case of @entity1829 . We evaluated its safety and effectiveness. METHODS: From 2012 to 2014, 1034 @entity1 underwent therapeutic ERCP. A total of 138 of them presented @entity1829 and were treated with eSNKP performed after 5 failed attempts of standard guidewire cannulation. Deep biliary cannulation rate was recorded, as well as intraoperative and postoperative complication rate. RESULTS: Successful biliary deep cannulation was achieved in 132/138 @entity1 (95.7%) by means of eSNKP. In 6 @entity1 (4.3%), cannulation failed even after eSNKP. ERCP was newly performed 72 hours later with successful and immediate guidewire biliary cannulation. Overall morbidity was 10.1% (14/138). No perforation occurred. @entity548 occurred in 4/138 cases (2.9%) and 10/138 @entity1 (7.2%) developed mild @entity788 . CONCLUSION: In case of @entity1829 , eSNKP followed by guidewire cannulation increases the successful deep biliary cannulation with low rate of complications.
