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Precut papillotomy using needle knife fashioned from discarded standard papillotomes
1Gastroenterology Unit, Kasturba Medical College, Manipal. info@mahe.ernet.in
Summary
Repurposed needle-knife papillotomes effectively facilitate precut papillotomy during ERCP, improving cannulation success and offering cost savings in endoscopic retrograde cholangiopancreatography procedures.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Surgical Innovation
Background:
- Precut papillotomy is crucial for accessing bile and pancreatic ducts during ERCP.
- Standard sphincterotomes can be modified into needle-knife papillotomes.
- Cost-effectiveness in medical procedures is an ongoing concern.
Purpose of the Study:
- To assess the efficacy of needle-knife papillotomes made from discarded standard sphincterotomes for precut papillotomy.
- To evaluate the success rate of ductal cannulation using these repurposed instruments.
- To determine the cost-saving potential of this technique in ERCP.
Main Methods:
- A retrospective review of 50 patients undergoing precut papillotomy for ERCP was conducted.
- Needle-knife papillotomes were fashioned from discarded standard pull-type sphincterotomes.
- Procedures included diagnostic (n=50) and therapeutic (n=36) ERCPs for bile or pancreatic duct access.
Main Results:
- Successful cannulation of the target duct was achieved in 93.6% (44/47) of diagnostic ERCPs.
- Therapeutic ERCP success rate was 67% (24/36), with specific success rates for bile and pancreatic ducts.
- Complications included cholangitis (16%) and pancreatitis (4%), with no instances of bleeding or perforation.
Conclusions:
- Repurposed needle-knife papillotomes are effective for precut papillotomy in ERCP.
- This technique demonstrates potential for significant cost containment in endoscopic retrograde cholangiopancreatography.
- The study highlights a practical approach to instrument reuse in interventional endoscopy.