Outcome of access sphincterotomy using a needle knife converted from a standard biliary sphincterotome

Cannulation fails in up to 10 % of all endoscopic retrograde cholangiopancreatographies (ERCPs). A standard sphincterotome can be converted to a needle knife to perform precut sphincterotomy (PCS). In this retrospective study, we analyzed cannulation rates, adverse events, and the percentage of patients requiring a second sphincterotome using a converted needle knife. Over a 7-year period, 3322 ERCPs were performed by one experienced therapeutic endoscopist; 1487 sphincterotomies were performed, 78 precut sphincterotomies using a converted needle knife. Successful cannulation using the converted needle knife was achieved in 96 % of cases at the initial procedure. Adverse events occurred in 17 % and post-ERCP pancreatitis was reported in 10 % of patients. A second sphincterotome was needed in 13 % of cases. This study shows a converted needle knife can be used for successful cannulation of either the biliary or the pancreatic duct after a failed cannulation with a standard sphincterotome, with a low percentage of adverse events anda reduction in the need for accessories.