Abstract
OBJECTIVES: Needle-knife fistulotomy is an advanced technique for gaining biliary access in endoscopic retrograde cholangiopancreatography (ERCP). This study assesses the hypothesis of whether biliary stenting after needle-knife fistulotomy could improve the safety of the ERCP. METHODS: A retrospective review of the medical records of patients who referred for ERCP between 2021-2024 was performed. All patients with naïve papilla and choledocholithiasis who underwent needle-knife fistulotomy were included in the study. Patients were categorized into the two groups of with and without biliary stent. RESULTS: Of the 402 included patients, 331 had successful stone extraction, among whom 50 (15.1%) and 281 (84.9%) recieved and not received a biliary stent, respectively. After 1:4 propensity score matching, age, sex, difficult cannulation, and pancreatic duct cannulation were comparable between the groups (p > 0.05). Patients with biliary stent had a borderline significant lower rate of post-ERCP pancreatitis (2.3% vs. 13.1%, p = 0.054). No delayed perforation was observed in either groups. There were no significant differences in cholangitis and bleeding between the groups (p > 0.05). CONCLUSIONS: This is the first study investigating the impact of prophylactic biliary stenting after needle-knife fistulotomy, suggesting that prophylactic biliary stenting after needle-knife fistulotomy and successful stone removal may improve the safety of ERCP by reducing the rate of post-ERCP pancreatitis. Further large-scale prospective studies are warranted to validate these findings.