Logo image
Back
SUBMUCOSAL INJECTION TO FACILITATE NEEDLE KNIFE SPHINCTEROTOMY, A NOVEL TECHNIQUE
Journal article   Open access   Peer reviewed

SUBMUCOSAL INJECTION TO FACILITATE NEEDLE KNIFE SPHINCTEROTOMY, A NOVEL TECHNIQUE

Kambiz Kadkhodayan, Shayan Irani, Sagar Pathak, Abdullah Abbasi, Saurabh Chandan, Deepanshu Jain and Muhammad K. Hasan
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, Vol.11(1), pp.12-15
01/2026
DOI: 10.1016/j.vgie.2025.08.005
PMCID: PMC12827025
PMID: 41584622
url
https://doi.org/10.1016/j.vgie.2025.08.005View
Published (Version of record) Open Access

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 female 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 CBD was not achieved. We subsequently decided to proceed with advanced cannulation using a NKS with submucosal lift. Three cc’s of hetastarch with methylene blue was injected 2 mm above the ampullary os, resulting in an adequate submucosal lift. A mucosal incision was made, starting at the ampullary os and extended cranially to the 12 O’clock position. Results Layer-by-layer dissection was performed and deep cannulation of the bile duct was obtained without adverse events. Conclusion In our patient, submucosal injection enhanced tissue-plane visualization during NKS, allowing for controlled and anatomically guided dissection.

Details

Metrics

18 Record Views
Logo image