University of Rochester, Strong Memorial Hospital Rochester, NY
Ashley Thompson, MD1, Natalie C. Penn, MD2, Nicholas Bartell, MD3, Krystle Bittner, MPH4, Sarah Enslin, PA-C3, Asad Ullah, MD3, Truptesh Kothari, MD, MS3, Vivek Kaul, MD, FACG3, Shivangi Kothari, MD, FACG3; 1University of Rochester, Strong Memorial Hospital, Rochester, NY; 2University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY; 3University of Rochester Medical Center, Rochester, NY; 4University of Rochester, Rochester, NY
Introduction: Successful endoscopic retrograde cholangiopancreatography (ERCP) is reliant upon cannulation of the targeted duct; however, standard methods of selective biliary cannulation have been reported to fail in 15-35% of cases. Needle knife sphincterotomy (NKS) can be utilized to achieve biliary access when conventional approaches fail. There is limited data available regarding the safety and efficacy of NKS in ERCP. Our aim was to assess the safety and efficacy of NKS in ERCP to achieve biliary access in cases with difficult cannulation at a high-volume academic tertiary care referral center. Methods: This study was an IRB-approved retrospective chart review of a prospectively maintained database of patients presenting for ERCP at our center between 6/1/17 and 5/31/2020. Any patient that underwent ERCP utilizing NKS for biliary access was eligible for inclusion. Patient, procedure and adverse events (AE) details were recorded. Analysis was performed using descriptive statistics (frequency distribution, mean, and standard deviation). Results: A total of 2,199 ERCP procedures were performed during the study period, of which 158 required NKS for biliary access in 155 patients. The majority of patients were female (52.9%) with a mean age of 61.7 years (Table 1). Procedural and safety data are summarized in Table 2. NKS was successful in achieving deep biliary cannulation in 91.1% (n = 144/158) of cases. ERCP was repeated in 9/14 patients that failed despite NKS (mean number of days following first attempt = 3.22), with successful biliary access in 66.7% (n = 6/9). The 30-day post-ERCP adverse event (AE) rate was 17.1% (n = 27/158; occurring at 6.4 ± 8.9days) and included: post-ERCP pancreatitis (n = 11; 7.0 %), perforation (n = 3; 1.9%), cholangitis (n = 1; 0.6%), post-sphincterotomy bleeding (n = 2; 1.3%), sepsis attributed to aspiration pneumonia (n = 1; 0.6%), obstructed CBD stent (n = 2; 1.3%), post-procedure arrhythmia (SVT) (n = 1; 0.6%), self-limited post-procedural abdominal pain (n = 1; 0.6%), AKI with concurrent C. difficle infection (n = 1; 0.6%), and death (n = 4; 2.5%). Of patients with post-ERCP pancreatitis, 9/11 (81.8%) had a PD stent placed. The majority of AE’s were mild or moderate in severity (n = 19/27; 70.3%). No deaths were associated with NKS or ERCP procedure. Discussion: In ERCP cases with difficult biliary cannulation, NKS is highly successful, safe and effective in achieving biliary access when standard techniques fail.
Disclosures: Ashley Thompson indicated no relevant financial relationships. Natalie Penn indicated no relevant financial relationships. Nicholas Bartell indicated no relevant financial relationships. Krystle Bittner indicated no relevant financial relationships. Sarah Enslin indicated no relevant financial relationships. Asad Ullah indicated no relevant financial relationships. Truptesh Kothari indicated no relevant financial relationships. Vivek Kaul indicated no relevant financial relationships. Shivangi Kothari indicated no relevant financial relationships.