Masood Muhammad Karim; Adeel Ur Rehman; Faisal Wasim Ismail; Om Parkash

doi:10.5946/ce.2023.228

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Letter to the Editor Comments on ‘Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography’: Masood Muhammad Karim^,, Adeel Ur Rehman, Faisal Wasim Ismail, Om Parkash; Clinical Endoscopy 2024;57(2):280-281.
DOI: https://doi.org/10.5946/ce.2023.228
Published online: February 1, 2024

Gastroenterology Section, Medicine Department, Aga Khan University Hospital, Karachi, Pakistan

Corresponding Author: Masood Muhammad Karim Gastroenterology Section, Medicine Department, Aga Khan University Hospital, Stadium road, Karachi, Pakistan E-mail: masoodkareem37@gmail.com

• Received: September 13, 2023 • Revised: September 18, 2023 • Accepted: September 23, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

See the article "Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography" on page 490.

This letter to the editor is in response to the article entitled “Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography”.”¹

We read with great interest the article about novel fistulotomy by Kuraishi et al.¹ In this article, the authors describe the novel fistulotomy technique named opening window fistulotomy, an initial procedure for securing biliary access in therapeutic endoscopic retrograde cholangiopancreatography (ERCP). This was a great initiative to establish a new technique for reducing the incidence of the most common post-ERCP adverse event.²^-⁴

In a prospective study, Jin et al.⁵ already deemed classic needle knife fistulotomy (NKF) as the primary biliary access for therapeutic ERCP in a high-risk post-ERCP pancreatitis (PEP) group safe and feasible. The European Society of Gastrointestinal Endoscopy also recommends NKF as the preferred precut technique in patients with a bile duct dilated down to the papilla.⁶

This novel technique fistulotomy (open window fistulotomy) has a comparative successful cannulation rate to that of classic NKF. However, the application of open window fistulotomy is low (27%) due to a smaller number of patients with long intraductal common bile duct (papilla roof size, >10 mm) as evident in this study.

Second, open window fistulotomy is better able to prevent PEP than the conventional method, while NKF has equal ability to open window fistulotomy to prevent PEP and a lower risk of perforation (1.8% vs. 3.3%), possibly due to the larger fistulotomy size and area.¹^,²

Therefore, in our opinion, classic fistulotomy to establish primary biliary access not only reduces PEP but also has less serious adverse events and can be performed in most patients without a papilla roof size restriction.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

None.

Author Contributions

Conceptualization: MMK, OP; Resources: AUR, FWI; Supervision: OP, FWI; Validation: all authors; Visualization: OP, MMK, AUR, FWI; Writing–original draft: MMK, OP, AUR; Writing–review & editing: all authors.

REFERENCES

1. Kuraishi Y, Hara K, Haba S, et al. Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography. Clin Endosc 2023;56:490–498.Article PubMed PMC PDF
2. Bailey AA, Bourke MJ, Williams SJ, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy 2008;40:296–301.Article PubMed
3. Larkin CJ, Huibregtse K. Precut sphincterotomy: indications, pitfalls, and complications. Curr Gastroenterol Rep 2001;3:147–153.Article PubMed PDF
4. Williams EJ, Taylor S, Fairclough P, et al. Are we meeting the standards set for endoscopy? Results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut 2007;56:821–829.Article PubMed PMC
5. Jin YJ, Jeong S, Lee DH. Utility of needle-knife fistulotomy as an initial method of biliary cannulation to prevent post-ERCP pancreatitis in a highly selected at-risk group: a single-arm prospective feasibility study. Gastrointest Endosc 2016;84:808–813.Article PubMed
6. Dumonceau JM, Andriulli A, Elmunzer BJ, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline-updated June 2014. Endoscopy 2014;46:799–815.Article PubMed

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Comments on ‘Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography’

Clin Endosc. 2024;57(2):280-281. Published online February 1, 2024

DOI: https://doi.org/10.5946/ce.2023.228

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