Needle-knife fistulotomy in patients with periampullary diverticula and difficult bile duct cannulation. 
Needle-knife fistulotomy has commonly been used for overcoming difficult bile duct cannulation.  Periampullary diverticula (PAD) can be an impediment to endoscopic retrograde cholangiopancreatography (ERCP) procedures.  There are little data on needle-knife fistulotomy in patients with PAD.  We evaluated the efficacy and safety of needle-knife fistulotomy between patients with and without PAD.  Data from December 2005 to October 2010 were reviewed.  Patients who underwent needle-knife fistulotomy were divided into the group with PAD and the group without PAD (control group).  The technical success and complications were compared.  A total of 3012 ERCP cases were analyzed.  Needle-knife fistulotomy was performed in 154 out of 3012 cases (5.1%) with 138 of these patients (89.6%) experiencing successful bile duct cannulation.  The overall cannulation success rate was not significantly different between PAD group (n=33) and control group (n =121) (93.9% vs 88.4%; P=0.523).  There was no significant difference in pancreatitis, bleeding and perforation between the two groups.  Needle-knife fistulotomy can be performed effectively and safely in patients with periampullary diverticula and difficult bile duct cannulation.