Needle knife papillotomy in a university referral practice. Safety and efficacy of a modified technique

To study the utility of needle knife papillotomy (NKP), we retrospectively reviewed 575 consecutive endoscopic retrograde cholangiopancreatography (ERCP) procedures performed over a 3.5-year period. Seventy patients (12.2%) underwent NKP utilizing a shallow ampullary mucosal incision followed by probing with a taper-tipped cannula. Usually a prelude to anticipated therapeutic intervention, NKP was also performed purely for diagnosis in 15 patients (21.4%). The incised ampulla was normal-sized in the majority (53 of 70, 75.7%), and ductal dilatation was present in 49 of 70 cases (70%). NKP was performed de novo in 63 patients, one of whom had Billroth II anatomy, and stent-guided NKP was performed in seven patients (10%), two of whom had Billroth II anatomy. Biliary access was immediate in 68 patients (97.1%) and successful 24 h later in two cases. The NKP incision was completed with a traction sphincterotome in 45 patients (64.3%). Complications occurred after NKP in five patients (7.1%), compared with 11 complications (4.2%) among a concurrent 261 patients who underwent standard ES without NKP. All complications following NKP were selflimited, including pancreatitis (n = 2) and bleeding (n = 2). Our experience indicates that NKP is versatile, effective, and safe with broad applicability in an academic referral practice.