A COMPARISON OF NKS VS TPS FOR DIFFICULT CANNULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Aims The timing of the precutting intervention is important for reducing the complications. The number of transpapillary cannulation attempts and that of pancreatic duct cannulations are two of the most important factors contributing to PEP .The aim of our study was to assess the efficacy and safety of needle knife sphincterotomy (NKS) compared with transpancreatic septotomy (TPS)

Methods we searched multiple databases(Medline, Embase, Cochrane) to identify RCTs comparing the role of NKS vs TPS in patients with difficult cannulation.Outcomemeasures werethe riskof PEP, cannulation rate and adverse events. Fixed and random models were usedas appropriate. Heterogeneity was assessed by measuring I².

Results we identified 5 RCTsfor a total of 903patients respectively randomized to TPS (551 and to NKS (352).No difference emerged in the rateof PEP (OR 0.62 95%CI 0.21-1.88), nor in adverse events (OR 1.71 95%CI 0.60-4.87), and in successfulcannulation ratee (OR. 1.70 95%CI 0.60-4.79).

Conclusions There is no increased risk of PEP in the NESgroup compared to ES before stent placement in patients with distal malignant biliary obstruction. According to our data, ES is not mandatory. However, due tothe small number of patients and the study heterogeneity more RCTs are required before a firmrecommendation could be made