Feasibility of using wire-guided needle-knife electrocautery for refractory biliary and pancreatic strictures

Gastrointest Endosc. 2013 May;77(5):752-8. doi: 10.1016/j.gie.2012.11.023. Epub 2013 Jan 26.

Abstract

Background: Endoscopic management of biliary or pancreatic strictures by stent insertion is well established. However, some high-grade strictures are refractory to dilation and stent placement with conventional methods.

Objective: To evaluate the safety and efficacy of the wire-guided electrotomy technique in dilating stiff biliary and/or pancreatic stenoses when ordinary methods failed.

Design: Retrospective analysis of a prospective database.

Setting: Tertiary referral university hospital.

Patients: This study involved 279 patients with biliary or pancreatic strictures who underwent ERCP for stenting.

Intervention: After conventional dilation failed, wire-guided needle-knife electrocautery was attempted to facilitate insertion of the dilating devices and eventually endoprosthesis.

Main outcome measurements: The successful treatment and drainage of biliary or pancreatic strictures.

Results: With wire-guided needle-knife cauterization, the success rate of stricture dilatation increased from 95.7% (267 of 279 patients) to 98.9% (276 of 279 patients). Dilation of stenoses was successful in 9 of 10 patients (90%) by using electrocautery with the wire-guided needle-knife technique. Postprocedure adverse events included self-limited bleeding, mild acute pancreatitis, hyperamylasemia, cholangitis, and biliary perforation. No procedure-related death occurred.

Limitations: Retrospective, single-center study and small sample size.

Conclusions: Wire-guided needle-knife electroincision appears to be effective for traversing refractory biliary or pancreatic strictures and can be considered as an alternative approach to conventional methods. However, the safety of such a technique needs to be further evaluated.

MeSH terms

  • Adult
  • Aged
  • Bile Ducts / injuries
  • Bile Ducts / pathology*
  • Bile Ducts / surgery
  • Cholangiopancreatography, Endoscopic Retrograde
  • Cholangitis / etiology
  • Constriction, Pathologic / surgery
  • Dilatation
  • Drainage / methods
  • Electrocoagulation* / adverse effects
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Ducts / pathology*
  • Pancreatic Ducts / surgery
  • Pancreatitis / etiology
  • Postoperative Hemorrhage / etiology
  • Retrospective Studies
  • Stents
  • Treatment Failure