Tip palpation of the intraduodenal biliary segment for needle-knife fistulotomy

Needle-knife access fistulotomy (NKF) involves using a needle-knife to cut into the intraduodenal segment of the bile duct, thereby avoiding the papilla. Previous studies suggest this procedure decreases the risk of post-ERCP pancreatitis and increases successful biliary cannulation compared with conventional methods. In this case series, we introduce an advanced endoscopic technique aimed at aiding endoscopists with successful NKF and broadening use of this procedure.

Here we describe a technique in which we use the sphincterotome and needle-knife to palpate the intraduodenal biliary segment before needle-knife instrumentation. Careful dissection is then performed along this axis before achieving biliary cannulation with the sphincterotome and guidewire.

All videos shown led to successful biliary cannulation with next-day discharges from the hospital and clinical success with biliary decompression.

Previous palpation for the bile duct may aid endoscopists with NKF. This may lead to wider adoption of NKF. Further prospective research is needed.