Needle-Knife Fistulotomy Versus Needle-Knife Papillotomy in Difficult Biliary Cannulation: A Systematic Review and...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for biliary and pancreatic diseases.
• Needle-knife fistulotomy (NKF) and needle-knife papillotomy (NKP) are common rescue techniques for difficult biliary cannulation.
• Comparative studies are needed to guide clinical decisions between NKF and NKP.

Purpose of the Study:

• To evaluate the efficacy and safety of NKF versus NKP.
• To compare these techniques as rescue methods for difficult biliary cannulation after failed conventional ERCP.

Main Methods:

• A meta-analysis of studies directly comparing NKF and NKP for difficult biliary cannulation.
• Searched PubMed, Scopus, Embase, and Web of Science databases.
• Calculated pooled odds ratios and 95% confidence intervals using a random-effect model.

Main Results:

• Four studies (823 patients) were analyzed; no significant difference in biliary cannulation success rate (91.7% NKF vs. 86.9% NKP).
• Overall adverse events were significantly lower with NKF (OR = 0.46).
• Pancreatitis and bleeding rates were similar; no significant differences in cholangitis, cholecystitis, perforation, or mortality.

Conclusions:

• NKF and NKP have comparable success rates for difficult biliary cannulation.
• NKF demonstrates a significantly better safety profile with fewer adverse events.
• NKF may be preferred due to its safety, with further RCTs recommended.