Needle knife papillotomy with discarded sphincterotomes: Cost effective and safe

Abstract

Background: Efficacy of therapeutic biliary endoscopy depends on the success rate of selective cannulation of common bile duct. Precut papillotomy using a needle knife is a technique used to improve access to common bile duct. The cost of the procedure increases exponentially with the use of special accessories like a needle knife. We evaluated the safety and efficacy of a needle knife made out of discarded sphincterotomes at our institute. Methods: Prospectively collected non-randomized data was analysed at an academic tertiary referral center. The study included all patients in a two-year period that underwent endoscopic retrograde cholangiopancreatography. The main outcome measures of the study were success and complications of precut papillotomy done using a needle knife shaped out of discarded sphincterotomes. Observations: 438 ERCPs were performed during the study period and 78 patients (17.81%) needed a precut papillotomy. Selective biliary cannulation after precut papillotomy with the newly prepared needle knife was successful in 100 % of cases. Complications seen in 7 % of cases, were similar to those observed in other studies and none of them were life threatening. Conclusion: Precut papillotomy using needle knife made out of discarded sphincterotomes is effective and safe when performed by an experienced endoscopist. In a developing economy where cost of medical treatment is a major obstacle in providing health care, small innovations like the above will help in decreasing the cost of endoscopic retrograde cholangiopancreatography.