Cutting Edge Access: Needle Knife Fistulotomy for Difficult Biliary Cannulation

Needle-knife fistulotomy has transitioned from a "last-ditch" technique to sometimes a primary approach in select patient populations by endoscopists. The major impetus for this change is due to consistent results showing a lower risk of post-ERCP pancreatitis compared to other pre-cut methods. This review article will go in-depth on the technique of needle-knife fistulotomy, the benefits and suspected complications of needle-knife fistulotomy compared to traditional sphincterotomy techniques and the evolution of NKF as a first-choice option for biliary cannulation.