NKS Does Not Increase the Risk of Pancreatitis in Patients with Difficult Biliary Cannulation

April 18, 2013

Michael P. Swan and colleagues conclude in Clinical Gastroenterology and Heptaology that early application of needle knife sphincterotomy (NKS) during difficult cannulation does not increase the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). The risk of PEP increases greatly after seven to eight attempts at or failure of cannulation.

Biliary cannulation is unsuccessful during 5 to 10 percent of endoscopic retrograde cholangiopancreatography (ERCP) procedures. Needle knife sphincterotomy (NKS) can improve success of cannulation but is often used as a last resort and is associated with post-ERCP pancreatitis (PEP). Michael P. Swan and colleagues evaluated the safety and efficacy of performing NKS during early stages of difficult cannulation and the relationship between difficult cannulation and the risk of PEP. Publishing in Clinical Gastroenterology and Heptaology, they conclude that early application of NKS during difficult cannulation does not increase the risk of PEP. The risk of PEP increases greatly after seven to eight attempts at or failure of cannulation. Further studies are required to assess whether early implementation of NKS during difficult cannulation reduces the development of PEP. 

Clinical Gastroenterology and Hepatology 2013: 11(4): 430-436.e1