Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy

Hirotoshi Fukatsu, Hirofumi Kawamoto, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Ken Hirao, Takashi Nakanishi, Osamu Mizuno, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kohsaku Sakaguchi

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22 Citations (Scopus)


Background: Although needle-knife precut papillotomy (NKPP) is considered a useful alternative for achieving selective biliary cannulation, controversy remains regarding the technical proficiency needed to perform the procedure and its safety. This study evaluated whether procedural experience with NKPP predicted either successful cannulation or the development of complications. Methods: This study retrospectively investigated 104 patients, out of 589 consecutive patients with native papillary, who underwent NKPP performed by a single endoscopist between October 2002 and July 2006. To demonstrate changes in NKPP, the 104 patients were divided chronologically into two groups according to periods: period A (October 2002 to September 2004) and period B (October 2004 to July 2006). Results: Of the 104 consecutive patients who underwent NKPP, 41 (41/267, 15%) were treated in period A and 63 (63/322, 20%) in period B. There was no significant difference in the overall success rate between periods A (90%) and B (98%) (p = 0.08). However, the initial success rate was higher in period B (95%) than in period A (80%) (p<0.05). The complication rates were not significantly different between the two groups (10% vs 16%; p = 0.56). Although all complications involved pancreatitis, severe pancreatitis was not observed. Conclusion: Whereas the initial success rate for NKPP can increase with procedural experience, the complication rate does not seem to decrease. Furthermore, the need for NKPP does not appear to decrease with increasing endoscopic retrograde cholangiopancreatography (ERCP) experience.

Original languageEnglish
Pages (from-to)2066-2072
Number of pages7
JournalSurgical Endoscopy
Issue number9
Publication statusPublished - Sept 2009


  • Biliary cannulation
  • Complication
  • ERCP
  • Endoscopic retrograde cholangiopancreatography
  • NKPP
  • Needle-knife precut papillotomy
  • Technical proficiency

ASJC Scopus subject areas

  • Surgery


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