Primary needle-knife fistulotomy versus rescue precut: a systematic review and meta-analysis of outcomes

Post written by Jay Bapaye, MD, from the Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA.


Precut sphincterotomy is a technique used when attempts at gaining biliary access with the help of standard catheters, cannulotomes, and guidewires have failed.

In our study, we tried to answer the question of how does a primary needle-knife fistulotomy (p-NKF) compare with traditional rescue precut in the hands of experienced endoscopists.

It was important to conduct this study because it was unclear whether repeated attempts at biliary cannulation or the precut procedure itself was a risk factor for post-ERCP pancreatitis (PEP).  

From a systematic review and meta-analysis of 5 studies, we found that the odds of developing PEP with p-NKF were lower than in the control group (odds ratio, .33; 95% confidence interval, .17-.66; I2 = 0%). The rates of successful biliary cannulation, procedure time, immediate and delayed bleeding rates, and perforation rates were comparable between the 2 groups.

This suggests that p-NKF is a safe tool that experienced endoscopists can use to reduce the risk of PEP without increasing the risk of other adverse events.


Preferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. NKF, needle-knife fistulotomy.

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