TY - JOUR AU - Siripornadulsilp, Surachai AU - Tongsiri, Nisit PY - 2019/05/23 Y2 - 2024/03/28 TI - Managing Difficult Cannulations in Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Control Trial Study of Precut Needle Knife Sphincterotomy versus Transpancreatic Sphincterotomy Technique JF - Siriraj Medical Journal JA - Siriraj Med J VL - 71 IS - 3 SE - Original Article DO - 10.33192/Smj.2019.27 UR - https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/190625 SP - 175-180 AB - <p><strong>Objective:</strong> To evaluate the success rate of cannulations and rate of procedure-related complications between needle&nbsp;knife sphincterotomy (NKS) and transpancreatic sphincterotomy (TPS) techniques, and to evaluate the most effective&nbsp;cannulation time to proceed with NKS or TPS.<br><strong>Methods:</strong> This study recruited 52 patients with inaccessible bile ducts by the standard cannulation at Khon Kaen&nbsp;Hospital from May 2012 to May 2015. Patients were randomly allocated to the NKS group (N=21) or the TPS group&nbsp;(N=21). Successful cannulations, and complications between NKS and TPS were collected and assessed.<br><strong>Results:</strong> Successful cannulations by TPS and NKS were achieved in 14 cases (53.8%) and 13 cases (50%) respectively&nbsp;(p value = 0.781). Post ERCP pancreatitis was found in 2 cases using TPS, and in 3 cases using NKS. There were&nbsp;3 cholangitis cases in TPS group, and 2 cholangitis cases in NKS group. Perforations were found in 3 cases and 1<br>case in TPS and NKS group, respectively. There were 4 deaths in this study, one case in TPS group and 3 cases in&nbsp;NKS group. Complications and mortality between TPS and NKS were not statistically significant (P&gt;0.05). After&nbsp;40 minutes of the ERCPs, there was less chance for a successful cannulation. Unsuccessful cannulations between<br>TPS and NKS was not statistically different according to the Kaplan-Meier analysis.<br><strong>Conclusion:</strong> TPS and NKS are able to increase successful cannulations. There are no significant differences in the&nbsp;cannulation success rate and rate of complications between the TPS and NKS. The appropriate time to terminate&nbsp;a cannulation in difficult cases is found to be 40 minutes.</p> ER -