The Needle - Knife Sphincterotomy over Pancreatic Stent: A Safe and Effective Technique?

Park, Jong Jae; Kim, Sun Suk; Yoon, Hyung Sun; Kang, Dong Hoon; Choi, Duck Joo; Kim, Ju Hyun

Abstract

BACKGROUND/AIMS
Needle-knife sphincterotomy (NKS) is an alternative technique to EST when selective bile duct cannulation can not be achieved with a variety of techniques or accessories. The risk of post-procedure pancreatitis is high, however, when papillary edema, sphincter of Oddi spasm, and the resulting restriction of pancreatic juice flow are induced by both mechanical injury associated with repeated cannulation attempts and possible burn injury due to NKS itself. Recently, nasopancreatic drainage and pancreatic stenting were suggested to be effective in preventing pancreatitis in patients with high risk of postprocedure pancreatitis and in patients who underwent NKS, respectively. The purpose of this study is to evaluate the role of pancreatic stenting on the clinical outcomes in patients with high risks of postprocedure pancreatitis who undergo NKS.
METHODS
Of the 119 patients who had undergone NKS, pancreatic stenting with 2-4 cm, 7Fr polyethylene biliary stent was performed prior to NKS in 13 patients (pancreatic stent group), and an incision was begun without pancreatic stenting at the papillary roop avoiding trauma of the papillary orifice and thus, reducing the risks of pancreatitis in 15 patients (control group). Both groups were at high risks of pancreatitis associated with repeated, unsuccessful bile duct cannulation attempts. In the two groups, the success rate of bile duct cannulation and the incidence of pancreatitis were analyzed and compared.