Rollhauser C, Johnson M, Al-Kawas F H
Division of Gastroenterology, Georgetown University Medical Center, Washington, DC 20007, USA.
Endoscopy. 1998 Oct;30(8):691-6. doi: 10.1055/s-2007-1001390.
Needle-knife papillotomy (NKP) has been shown to be a useful alternative when standard techniques fail to provide access during ERCP. A retrospective review was conducted to reevaluate the indications, efficacy, and complications of NKP at a tertiary referral center.
A total of 1205 therapeutic endoscopic retrograde cholangiography procedures (ERCPs) were reviewed. Sixty-eight patients (5.6%) had undergone NKP after an established algorithm of techniques had failed to provide access. The NKP results were analyzed in two periods, including initial experience with 470 ERCPs (group 1, NKP n = 22) and later experience with 735 patients (group 2, NKP n = 46).
Immediate free cannulation in group 1 was achieved in 14 of 22 patients (64%), vs. 34 of 46 (74%) in group 2. The delayed cannulation rate was five of eight patients in group 1 (62.5%) vs. 11 of 12 in group 2 (92%). The success rate was 19 of 22 patients in group 1 (86%) vs. 45 of 46 in group 2 (98%). The overall success rate was 64 of 68 (94%). Successful cannulation led to a therapeutic intervention in 94% of these patients. A complication rate of 6%, without mortality, was noted.
NKP is a valuable tool that allows a high success rate for cannulation, with a low complication rate. The success rate increases with operator experience. NKP should be carried out by experienced endoscopists after standard maneuvers fail to provide access, and when cannulation is likely to be followed by a therapeutic intervention.
当标准技术在ERCP过程中无法实现胆管插管时，针刀乳头切开术（NKP）已被证明是一种有用的替代方法。在一家三级转诊中心进行了一项回顾性研究，以重新评估NKP的适应症、疗效和并发症。
共回顾了1205例治疗性内镜逆行胆管造影术（ERCP）。68例患者（5.6%）在既定的技术算法未能实现胆管插管后接受了NKP。NKP结果分两个阶段进行分析，包括最初470例ERCP的经验（第1组，NKP n = 22）和后来735例患者的经验（第2组，NKP n = 46）。
第1组22例患者中有14例（64%）立即成功插管，而第2组46例中有34例（74%）。第1组8例患者中有5例（62.5%）延迟插管，而第2组12例中有11例（92%）。第1组22例患者中有19例（86%）成功率，第2组46例中有45例（98%）。总体成功率为68例中的64例（94%）。成功插管导致这些患者中有94%接受了治疗性干预。观察到并发症发生率为6%，无死亡病例。
NKP是一种有价值的工具，插管成功率高，并发症发生率低。成功率随操作者经验增加而提高。NKP应由经验丰富的内镜医师在标准操作未能实现胆管插管且插管后可能进行治疗性干预时进行。
