The Experiences of 416 cases of Difficult Papillosphincterectomy Using Needle-knife / 中国微创外科杂志

ABSTRACT

Objective To explore skills and values of needle-knife in difficult papillosphincterotomy.Methods 222 cases underwent needle-like fenestration(NKF),and other 194 cases directly underwent needle-knife papillotomy(NKP) using needle-knife.Results The success rate of operation in the NKF Group and NKP Group was 75.2%(167/222) and 97.9%(190/194) respectively,with total success rate 85.8%(357/416).Infections of biliary tract occurred in 5 cases(1.2%) after operation,in which 3 cases were treated by surgical biliary tract drainage,2 cases were placed drainage tubes under endoscope once again and administrated antibiotics for controlling infection.Pancreatitis occurred in 24 cases(5.8%) postoperatively,in which 1 case of acute severe pancreatitis was cured with abdominal paracentesis drainage in 3 sites,other 23 cases were given medical conservative treatment.1 cases had massive bleeding of incision and was cured by injecting sclerosing agent under endoscope.Conclusions Using niddle-knife can make papillotomy successful in most of standard EST or pre-cut failure.The success rate of NKP is significantly higher than that of NKF,and re-NKP can improve the success rate without increasing severe complications and death mortality,but NKP should be restricted to duodenal hypo-papilla and stenotic terminal of common bile duct.