Precut papillotomy using needle knife fashioned from discarded standard papillotomes.

ABSTRACT

AIM: To evaluate the results of precut papillotomy using needle-knife papillotomes fashioned from discarded standard sphincterotomes. METHODS: Case records of 50 patients undergoing precut papillotomy for access to either common bile duct or pancreatic duct during endoscopic retrograde cholangiopancreatography were reviewed. Precut was performed using needle-knife papillotomes fashioned from standard pull-type sphicterotomes that were discarded because of broken cutting wires. A diagnostic procedure was planned in all 50 patients (bile duct = 39, pancreatic duct = 9, both ducts = 2) and therapeutic procedure in 36 patients (bile duct = 31, pancreatic duct = 5). RESULTS: Of the 47 patients who needed precut prior to diagnostic ERCP, 44 (93.6%) underwent successful cannulation of the duct of choice. Therapeutic procedures were planned in 36 patients; these were successful in 24 (67%; bile duct = 22, pancreatic duct = 2). The complications included cholangitis in 8 patients (16%) and pancreatitis in 2 (4%). None had bleeding or perforation. CONCLUSIONS: Precut needle-knife papillotomes fashioned from discarded standard sphincterotomes can be used effectively and can help in cost containment in endoscopic retrograde cholangiopancreatography.