Endoscopy 2020; 52(S 01): S149
DOI: 10.1055/s-0040-1704459
ESGE Days 2020 ePoster Podium presentations
Thursday, April 23, 2020 11:30 – 12:00 ERCP: Challenging access ePoster Podium 5
© Georg Thieme Verlag KG Stuttgart · New York

OUTCOMES OF PRECUT NEEDLE KNIFE FISTULOTOMY BASED ON THE ENDOSCOPIC MORPHOLOGY OF THE AMPULLA OF VATER AND OF THE SIZE OF BILE DUCT

J Fernandes
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Department of Gastroenterology, Viana do Castelo, Portugal
,
M Moreira
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Department of Gastroenterology, Viana do Castelo, Portugal
,
G Alexandrino
2   Professor Doutor Fernando Fonseca Hospital, Department of Gastroenterology, Amadora, Portugal
,
T Araújo
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Department of Gastroenterology, Viana do Castelo, Portugal
,
D Horta
2   Professor Doutor Fernando Fonseca Hospital, Department of Gastroenterology, Amadora, Portugal
,
L Lourenço
2   Professor Doutor Fernando Fonseca Hospital, Department of Gastroenterology, Amadora, Portugal
,
J Canena
2   Professor Doutor Fernando Fonseca Hospital, Department of Gastroenterology, Amadora, Portugal
3   Nova Medical School/Faculty of Medical Sciences, Department of Gastroenterology - Lisbon, Portugal
4   Cintesis - Center for Health Technology and Services Research, Porto, Portugal
,
L Lopes
1   Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Department of Gastroenterology, Viana do Castelo, Portugal
5   Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
6   ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims Previous studies have suggested that the success and complications of precut needle knife fistulotomy (NKF) for achieving biliary access is largely dependent of the endoscopic morphology of the ampulla of Vater and also of the bile duct size. However, no study has addressed this topic. This study evaluated the outcomes of NKF on the basis of the morphology of the major papilla and of the size of the bile duct.

    Methods This was a prospective multicenter study of all consecutive patients who were submitted toearly NKF attempt for biliary access between August 2017 and August 2019. We evaluated the success rate and complications of NKFbased on the following parameters: transverseand longitudinal measuresof the papilla obtained using a visual method; diameter of the terminal CBD (t-CBD)measured 1 cm from the papilla using fluoroscopic images. Papilla were classified using a previously validated international classification of the major papilla into 7 categories. Outcomes were evaluated by a binary response regression models.

    Results We included 275 patients submitted to NKF, median age 75 years (17-97), 158 women(57.45%). NKF were performed in: 46flat typepapillas(16,67%), 102prominent tubular non-pleated (37,21%), 74prominent tubular pleated(26,74%), 27prominent bulging(9,69%), 3 intradiverticular(1,09%), 10diverticular border(3,64%), 13unclassified(4,65%). The cannulation rate was 97,07%. The post-ERCP complications rate were9,09% (n= 25), with pancreatitis rate=6,18% (n=17)and no deaths. Cannulation success and complications were not significantly different among the seven papilla categories. In the regression model, cannulation and complications were not explained by the papilla morphology and the CBD diameter(Overall F-Test=0,46;p< 0,80).

    Conclusions The biliary cannulation and post-ERCP complications are not associated with papillary morphology or the distal size ofCBD. The decision to use NKF for biliary access shouldnot be conditioned by the papillary morphology.


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