Needle Knife Fistulotomy Versus Partial Ampullary Endoscopic Mucosal Resection for Difficult Biliary Cannulation: a prospective randomised controlled trial

Aims Cannulation success with standard techniques is reported to be around 90%. Even in expert hands and despite all efforts, it can be challenging that needs an alternate intervention. Needle-knife fistulotomy (NKF) is recommended as the initial technique for pre-cutting because the rate of post-ERCP pancreatitis (PEP) is significantly low. Still, it's performed as a free-hand technique without using a guidewire which may cause complications such as perforation and bleeding. We recently described a novel technique; partial ampullary mucosal resection (PA-EMR) for difficult biliary cannulation which may overcome some of NKF's limitations. Our aim was to compare the efficacy and safety of PA-EMR vs NKF [1] [2] [3] [4].