Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 17, Number 3, June 2024, pages 101-108

Needle-Knife Fistulotomy Versus Needle-Knife Papillotomy in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis

Figure 1. PRISMA flow chart of study inclusion. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2. Forest plot of biliary cannulation success rate. NKF: needle-knife fistulotomy; NFP: needle-knife papillotomy; ERCP: endoscopic retrograde cholangiopancreatography; OR: odds ratio; CI: confidence interval.

Figure 3. Forest plot of (a) overall rate of adverse events and (b) post-ERCP pancreatitis. NKF: needle-knife fistulotomy; NFP: needle-knife papillotomy; ERCP: endoscopic retrograde cholangiopancreatography; OR: odds ratio; CI: confidence interval.

**Table 1.** Characteristics of Included Studies
Study	Design and location	Indication of ERCP	Sample size	Mean age (years)	Sex (M/F)	Quality of studies
M: male; F: female; NKF: needle-knife fistulotomy; NFP: needle-knife papillotomy; ERCP: endoscopic retrograde cholangiopancreatography; CBD: common bile duct.
Katsinelos et al, 2012 [12]	Retrospective, Greece	Choledocholithiasis, CBD cancer, pancreatic cancer, gallbladder cancer, metastatic lymphadenopathy, biliary leak	78	129	72 (36 - 86)	72 (32 - 91)	34/44	58/71	Moderate
Katsinelos et al, 2014 [11]	Retrospective, Greece	Choledocholithiasis, pancreatitis, biliary cancer, leak, benign biliary stricture, pancreatic cancer	111	164	-	-	-	-	Moderate
Mavrogiannis et al 1999 [7]	RCT, Greece	Choledocholithiasis, malignant bile duct stricture, sludge in the bile duct, dilated CBD, sphincter of Oddi dysfunction	74	79	62.1 (29 - 83)	59.3 (20 - 91)	-	-	High
Zhang et al, 2022 [10]	RCT, China	Choledocholithiasis, malignant biliary stricture, benign biliary stricture, cholangitis	113	75	65.6 ± 9.6	68.2 ± 10.6	62/51	40/35	High

Table 1. Characteristics of Included Studies

Study

Design and location

Indication of ERCP

Sample size

Mean age (years)

Sex (M/F)

Quality of studies

NKF

NKP

NKF

NKP

NKF

NKP

M: male; F: female; NKF: needle-knife fistulotomy; NFP: needle-knife papillotomy; ERCP: endoscopic retrograde cholangiopancreatography; CBD: common bile duct.

Katsinelos et al, 2012 [12]

Retrospective, Greece

Choledocholithiasis, CBD cancer, pancreatic cancer, gallbladder cancer, metastatic lymphadenopathy, biliary leak

129

72 (36 - 86)

72 (32 - 91)

34/44

58/71

Moderate

Katsinelos et al, 2014 [11]

Retrospective, Greece

Choledocholithiasis, pancreatitis, biliary cancer, leak, benign biliary stricture, pancreatic cancer

111

164

Moderate

Mavrogiannis et al 1999 [7]

RCT, Greece

Choledocholithiasis, malignant bile duct stricture, sludge in the bile duct, dilated CBD, sphincter of Oddi dysfunction

62.1 (29 - 83)

59.3 (20 - 91)

High

Zhang et al, 2022 [10]

RCT, China

Choledocholithiasis, malignant biliary stricture, benign biliary stricture, cholangitis

113

65.6 ± 9.6

68.2 ± 10.6

62/51

40/35

High

**Table 2.** Individual Complications and Biliary Cannulation Success Rate
	Total no. of patients	Rates of successful cannulation	Total adverse events	PEP	Bleeding	Perforation	Cholangitis	Asymptomatic hyperamylasemia
NKF: needle-knife fistulotomy; NFP: needle-knife papillotomy; PEP: post-ERCP pancreatitis; ERCP: endoscopic retrograde cholangiopancreatography.
Katsinelos et al, 2012 [12]	78	129	72	108	6	33	2	27	4	5	0	1	-	-	-	-
Katsinelos et al, 2014 [11]	111	164	-	-	7	28	-	-	-	-	-	-	-	-	-	-
Mavrogiannis et al, 1999 [7]	74	79	67	70	8	12	0	6	5	4	2	2	1	0	0	1
Zhang et al, 2022 [10]	113	75	104	68	10	7	6	5	3	1	1	0	0	1	0	0

Table 2. Individual Complications and Biliary Cannulation Success Rate

Total no. of patients

Rates of successful cannulation

Total adverse events

PEP

Bleeding

Perforation

Cholangitis

Asymptomatic hyperamylasemia

NKF

NKP

NKF

NKP

NKF

NKP

NKF

NKP

NKF

NKP

NKF

NKP

NKF

NKP

NKF

NKP

NKF: needle-knife fistulotomy; NFP: needle-knife papillotomy; PEP: post-ERCP pancreatitis; ERCP: endoscopic retrograde cholangiopancreatography.

Katsinelos et al, 2012 [12]

129

108

Katsinelos et al, 2014 [11]

111

164

Mavrogiannis et al, 1999 [7]

Zhang et al, 2022 [10]

113

104