Title: Results of Needle Knife Sphincterotomy at Chris Hani Baragwaneth Academic Hospital
Authors: Abdulwhab Almahroug,,, Jones AO Omoshoro-Jones,, Mahmoud Alalaqi,,,, Azab Elsayed Azab
Volume: 8
Issue: 11
Pages: 58-64
Publication Date: 2024/11/28
Abstract:
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic skill by experts to image the pancreato-biliary tree using a combination of luminal side-viewing endoscopy and fluoroscopy. Needle knife sphincterotomy (NKS) is one of ERCP techniques used to facilitate access to common bile duct when standard cannulation has failed. Aim: To determine the overall and success rates of NKS, reasons or indications and associated specific procedure related outcomes were analysed. Methods: a retrospective descriptive analysis of CHBAH ERCP database from 2012 - 2016. The study included all adult (?18 years) patients who underwent ERCP at CHBAH during the study period. Results: 2493 ERCPs, standard technique was employed in 86.0% (2142/2493), NKS was used in 14% (351/2493) of the procedures, In the NKS group, successful biliary cannulation 64.2% (225/351) whilst 35.8% (126/351) were unsuccessful. Thus, biliary cannulation was accomplished in 2367 ERCPs performed by standard and NKS techniques. The overall success rate of biliary cannulation was 95% in the entire group. Complications associated with NKS was 14.2% (50/351), Specific NKS related complications were 11.1% in form of bleeding 5.2%, false tract formation 3.10%, duodenal perforation 1.7% (mostly retroperitoneal instrument type and managed non operatively), ampullary oedema 1.10%. Conclusion: The result of NKS in the study compares well with reported large series, However, NKS requires experience and should be performed by senior endoscopist. NKS is quite safe as the complications in comparison with standard technique was not statistically significant, Improved documentation of PEP will provide a better picture in the future.