الفهرس 
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Abstract
Suprapapillary puncture using the free hand needle knife is useful
in allowing biliary access when standard methods of biliary cannulation
have failed. There are several techniques to gain biliary access, like
precut sphincterotomy using the pull type sphincterotome, placement of a
pancreatic guidewire or stent and novel devices, such as endoscopic
scissors, endoscopic dissection by using a cotton swab and papillectomy.
The aim of this study is to compare the safety and efficacy of the
suprapapillary puncture technique using the free hand needle knife with
other techniques used for biliary access after failure of the standard
transpapillary biliary cannulation as regard immediate and long term
outcomes.
In order to fulfill this aim, a prospective randomized controlled
clinical trial was conducted at the Gastrointestinal Endoscopy Unit of the
Internal Medicine Department - Zagazig University Hospitals in the
period from December 2008 to December 2009. A total number of 112
patients were enrolled in the study from which 70 cases fulfilled the
inclusion criteria. The included cases were subdivided according to the
technique used into group A which included 15 patients who underwent
a suprapapillary puncture using the needle-knife as an access to the bile
duct after failure of transpapillary wire - guided cannulation, group B
which included 15 patients who underwent a precut using the standard
pull sphincterotome as an access to the bile duct after failure of
transpapillary wire - guided cannulation, group C which included 20
patients who underwent a conventional transpapillary wire - guided
cannulation without sphincterotomy, group D which included 20