Background and study aim: Cannulation of the common bile duct may require invasive procedures; such procedures may carry an increased risk of complications. This study aimed at comparing the safety and efficacy of the needle-knife fistulotomy with other techniques in cirrhotic patients after failure of the standard cannulation using the free hand needle knife.
Patients and methods:Seventy cirrhotic patients were included and were divided into: Group A; 15 patients who underwent a needle-knife fistulotomy using the needle–knife after failure of transpapillary wire – guided cannulation. Group B : 15 patients who underwent a precut using the standard pull sphincterotome after failure of transpapillary wire – guided cannulation. Group C : 20 patients who underwent a conventional transpapillary wire – guided cannulation without sphincterotomy. Group D : 20 patients who underwent a conventional transpapillary wire – guided cannulation with standard sphincterotomy. Cannulation was evaluated for duration, number of trials, use of aiding instruments and success rate.
Results : Success rate of CBD cannulation and fair dye drainage was reported in 93.3% and 73.3%, 86.7% and 80%, 85% and 70%, 85% and 80% of patients in groups A,B, C and D respectively, with no statistically significant difference among the four groups. The only complication reported in group A was bleeding (three patients). No statistically significant difference among the four groups regarding post-procedural complications was noticed.
Conclusion : Suprapapillary needle – knife fistulotomy can be used in cirrhotic patients when standard biliary cannulation proves to be difficult, it is associated with a high success rate and a low complication risk