Rescue Needle Knife Papillotomy Endoscopic Retrograde Cholangiopancreatography (ERCP) Cannulation: Success and Complications in a Retrospective Comparative Study With Procedure Time-Matched Controls.

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP) is a crucial endoscopic procedure for pancreato-biliary diseases for diagnostic and therapeutic purposes. Although commonly performed, difficult biliary cannulation (DBC) cases remain challenging when using conventional technology alone.

OBJECTIVE

This study aimed to assess the efficacy and safety of rescue needle knife papillotomy (RNKP) compared to sphincterotomy only (SPTO) in DBC.

Methods

A retrospective observational study with sequential intervention analysis to evaluate outcomes between the SPTO and RNKP groups among endoscopic sphincterotomy (EST)-naïve cases that underwent ERCP in Sheikh Khalifa Specialty Hospital in the UAE. RNKP was performed after an unsuccessful conventional cannulation attempt with SPTO, utilizing the delicate technique of a needle knife catheter. Comparative analysis of procedural outcomes and adverse events was conducted using the procedure time-matched case pairs of both groups.

RESULTS

Among 333 EST-naïve cases, SPTO was attempted initially in all patients, achieving successful cannulation in 277 (83.2%). In 56 cases where SPTO failed, the RNKP technique was applied, resulting in 55 successful cannulations with only one overall failure, leading to a total cannulation success rate of 332 (99.1%). After 1:1 time-matched case-control selection, 43 case-control pairs of SPTO vs. RNKP groups were analyzed. There were no statistically significant differences in post-ERCP complications between the two groups: cholangitis occurred in 2 cases (5.6%) in the SPTO group vs. 3 (7.3%) in the RNKP group (p=0.855); pancreatitis occurred in 1 (2.3%) vs. 3 (7.0%) (p=0.609); bleeding occurred in 0 (0%) vs. 1 (2.3%); and perforation did not occur in either group (0%).

CONCLUSION

RNKP is a highly effective rescue technique for difficult biliary cannulation, significantly increasing success rates following failed conventional SPTO cannulation, without elevating complication risks. This approach offers valuable clinical utility, especially for early-career endoscopists managing complex ERCP cases.