The needle knife: a valuable tool in diagnostic and therapeutic ERCP.

Using monopolar electrocautery technique, we have used both an electrified guide wire and a needle-tipped sphincterotome to successfully enter the common bile duct, subsequently image it, and perform therapeutic procedures when by virtue of the patient's anatomy, or because of tumor, this had not been possible using conventional ERCP catheters. In an initial group of 45 patients using the needle-tipped sphincterotome, clinically significant complications occurred in 3 patients but were not of a serious nature. The technique was an effective method for achieving both diagnostic ERCP and therapeutic maneuvers in 43 of 45 patients. We stress that this technique should only be attempted by those with long experience in ERCP and related procedures.