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

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.