Submucosal injection to facilitate needle-knife sphincterotomy: a novel technique.

ABSTRACT:

Background and aims

Needle-knife sphincterotomy (NKS) is a valuable rescue technique for biliary access but carries an increased risk of bleeding and perforation, particularly in flat (type 1) ampullae. Such adverse events typically result from poor visualization or differentiation of the various tissue planes during NKS. We describe a novel technique using submucosal dye injection to better visualize anatomical planes during dissection.

Methods

A 59-year-old woman with a pancreatic head mass and obstructive jaundice was referred for ERCP. EUS-guided biopsy confirmed pancreatic adenocarcinoma. She was found to have a flat ampulla during ERCP. Despite multiple attempts using a standard sphincterotome, deep cannulation of the common bile duct was not achieved. We subsequently

SUBMITTER: Kadkhodayan K 

PROVIDER: S-EPMC12827025 | biostudies-literature | 2026 Jan

REPOSITORIES: biostudies-literature