Needle knife sphincterotomy (NKS)

A helpful and safe adjunct to ERCP in a select population

Carlos Rollhauser, M. Johnson, F. H. Al-Kawas

Research output: Contribution to journalArticle

Abstract

NKS has been shown to be a useful alternative when standard techniques fail to provide access during ERCP. We have conducted a retrospective review to reevaluate the indications, efficacy and complications of NKS at a tertiary referral center. Methods: 1202 consecutive ERCP's in patients aged 3-90 (mean age 64.6) were reviewed using our endoscopy database. 65 patients underwent NKS (5.4%) after implementation of an established algorithm of techniques (standard cannula, sphincterotome and glidewire) for 15-20 min. had failed to provide access. NKS was analyzed according to two periods, involving our initial experience with 470 ERCP's (group I, NKS n = 22; partially reported before) and with a second group of 732 patients (group II, NKS n= 45). In our unit, all complications are prospectively recorded. Results: the indications for ERCP were jaundice (31%); CBD stones (20%); abnormal liver enzymes (20%); abdominal pain (12%); recurrent pancreatitis (11%); miscellaneous (6%). Immediate free cannulation rate in group I was 14/22 (64%) vs. 31/43 (72%) in group II; delayed cannulation 5/22 (23%) vs. 11/43 (26%); success rate 19/22 (86%) vs. 42/43 (98%). Overall success rate was 61/65 (94%). Four failures were recorded and associated with malignant CBD obstruction in 2 patients; pancreatico-cutaneous fistula in 1 and biliary stricture in 1. Two of these patients were ultimately cannulated in a rendezvous procedure. The final diagnosis/therapeutic intervention in patients who underwent NKS were stone extraction in 16 patients (25%); SOD 16 (25%); malignant CBD obstruction 12 (18%); biliary strictures 15 (23%); Chronic pancreatitis/PD stricture in 2 (3%) and miscellaneous in 4 (6% [idiopathic pancreatitis, pancreatico-cutaneous fistula, postoperative biliary leak and normal study ]). A complication rate of 6% was noted: mild bleeding in 2 patients, mild perforation and pancreatitis in 1 patient each; 3 complications occurred in group I and only 1 complication in group II. No patient mortality was encountered. Conclusions: (1) NKS is a valuable tool that allows a high success rate of cannulation with a low complication rate. (2) The success rate of cannulation after NKS improves and the complication rate decreases as the volume of procedures performed increases. (3) NKS should he done by experienced endoscopists after standard maneuvers fail to provide access and when access to the desired duct is likely to be followed by an endoscopic intervention.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Volume45
Issue number4
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

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Endoscopic Retrograde Cholangiopancreatography
Needles
Population
Catheterization
Pancreatitis
Cutaneous Fistula
Pathologic Constriction
Chronic Pancreatitis
Jaundice
Tertiary Care Centers
Abdominal Pain
Endoscopy
Databases
Hemorrhage
Mortality

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

Cite this

Needle knife sphincterotomy (NKS) : A helpful and safe adjunct to ERCP in a select population. / Rollhauser, Carlos; Johnson, M.; Al-Kawas, F. H.

In: Gastrointestinal Endoscopy, Vol. 45, No. 4, 01.01.1997.

Research output: Contribution to journalArticle

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abstract = "NKS has been shown to be a useful alternative when standard techniques fail to provide access during ERCP. We have conducted a retrospective review to reevaluate the indications, efficacy and complications of NKS at a tertiary referral center. Methods: 1202 consecutive ERCP's in patients aged 3-90 (mean age 64.6) were reviewed using our endoscopy database. 65 patients underwent NKS (5.4{\%}) after implementation of an established algorithm of techniques (standard cannula, sphincterotome and glidewire) for 15-20 min. had failed to provide access. NKS was analyzed according to two periods, involving our initial experience with 470 ERCP's (group I, NKS n = 22; partially reported before) and with a second group of 732 patients (group II, NKS n= 45). In our unit, all complications are prospectively recorded. Results: the indications for ERCP were jaundice (31{\%}); CBD stones (20{\%}); abnormal liver enzymes (20{\%}); abdominal pain (12{\%}); recurrent pancreatitis (11{\%}); miscellaneous (6{\%}). Immediate free cannulation rate in group I was 14/22 (64{\%}) vs. 31/43 (72{\%}) in group II; delayed cannulation 5/22 (23{\%}) vs. 11/43 (26{\%}); success rate 19/22 (86{\%}) vs. 42/43 (98{\%}). Overall success rate was 61/65 (94{\%}). Four failures were recorded and associated with malignant CBD obstruction in 2 patients; pancreatico-cutaneous fistula in 1 and biliary stricture in 1. Two of these patients were ultimately cannulated in a rendezvous procedure. The final diagnosis/therapeutic intervention in patients who underwent NKS were stone extraction in 16 patients (25{\%}); SOD 16 (25{\%}); malignant CBD obstruction 12 (18{\%}); biliary strictures 15 (23{\%}); Chronic pancreatitis/PD stricture in 2 (3{\%}) and miscellaneous in 4 (6{\%} [idiopathic pancreatitis, pancreatico-cutaneous fistula, postoperative biliary leak and normal study ]). A complication rate of 6{\%} was noted: mild bleeding in 2 patients, mild perforation and pancreatitis in 1 patient each; 3 complications occurred in group I and only 1 complication in group II. No patient mortality was encountered. Conclusions: (1) NKS is a valuable tool that allows a high success rate of cannulation with a low complication rate. (2) The success rate of cannulation after NKS improves and the complication rate decreases as the volume of procedures performed increases. (3) NKS should he done by experienced endoscopists after standard maneuvers fail to provide access and when access to the desired duct is likely to be followed by an endoscopic intervention.",
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