Comparative effectiveness of endoscopic plantar fasciotomy, needle knife therapy, and conventional painkillers in the treatment of plantar fasciitis: a real-world evidence study.

Plantar fascia (PF) is the commonest causes of foot pain in the adult population. Several surgical treatments are available to treat PF. This study was aimed to investigate the clinical efficacy of three different treatments for plantar fasciitis. It was conducted among 60 patients, divided equally into three treatment groups named Needle Knife Therapy, Endoscopic Plantar Fasciotomy, and Conventional Painkillers. Descriptive and analytical analysis were done by using SPSS 25 software. VAS and AOFAS scores were analyzed. The maximum (n = 31) participants were in 41-60 year age range group with normal BMI. These differences of mean VAS and AOFAS pain scores between different treatment groups were statistically significant (One-way ANOVA, p < 0.01). Both scores found lower in the Endoscopic Plantar Fasciotomy group. This study opens a new window of knowledge to achieve sustained pain relief and functional improvement. Moreover, the superiority of Endoscopic Plantar Fasciotomy in treating plantar fasciitis compared to Needle Knife Therapy and Conventional Painkillers was explored.

Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation?

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a variety of adverse events (AEs). One of the most important AEs is post-ERCP pancreatitis (PEP), which is most common in cases of difficult biliary cannulation. Although the precut technique has been reported as a PEP risk factor, recent studies indicate that early precut could reduce PEP, and that precut itself is not a risk factor. AIM: To evaluate the safety of the precut technique, especially in terms of PEP. METHODS: We conducted a retrospective study, spanning the period from November 2011 through December 2021. It included 1556 patients, aged ≥ 20 years, who underwent their initial ERCP attempt for biliary disease with a naïve papilla at the Kawasaki University General Medical Center. We compared the PEP risk between the early precut and the delayed precut group. RESULTS: The PEP incidence rate did not significantly differ between the precut and non-precut groups. However, the PEP incidence was significantly lower in the early precut group than the delayed precut group (3.5% vs 10.5%; P = 0.02). The PEP incidence in the delayed precut group without pancreatic stent insertion (17.3%) was significantly higher compared to other cases (P < 0.01). CONCLUSION: Our findings indicate that early precut may reduce PEP incidence. If the precut decision is delayed, a pancreatic stent should be inserted to prevent PEP.

Ultrasound-guided needle knife release for stenosing tenosynovitis of the flexor pollicis longus: a prospective randomized controlled trial.

PURPOSE: This study aimed to evaluate the efficacy and safety of ultrasound-guided needle knife release in the treatment of stenosing tenosynovitis of the flexor pollicis longus. METHODS: In this prospective trial, 60 patients with clinically and ultrasonographically confirmed stenosing tenosynovitis of the flexor pollicis longus were randomly allocated to 1 of 3 groups: ultrasound-guided needle knife release (n = 20), traditional conservative treatment (n = 20), and open surgery (n = 20). The primary outcome measure was the Quinnell grade of triggering severity. Secondary outcomes comprised pain intensity (on visual analog scale), satisfaction (5-point Likert scale), and complications. Outcomes were evaluated at baseline, 1 week, 1 month and 3 months post-intervention by blinded assessors. RESULTS: At all follow-up time points, the needle knife release group demonstrated significantly lower Quinnell grades (p < 0.05) and pain scores (p < 0.001) than the conservative treatment group; satisfaction was greater in the needle knife release group compared to the conservative treatment group at 1 month (p = 0.002) and 3 months (p < 0.001). There were no significant differences in outcomes between the needle knife release group and the open surgery group. The overall complications rate was 5% in the needle knife release group, 10% in the conservative treatment group, and 15% in the open surgery group (p = 0.574). CONCLUSION: Ultrasound-guided needle knife release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus, with outcomes that are better than with traditional conservative treatment and similar to those of open surgery.

Needle Knife Stricturoplasty for Hepaticojejunostomy Stricture After Whipple Procedure.

Hepaticojejunostomy anastomotic stricture is a relatively uncommon postoperative complication after a Whipple procedure. However, they are increasingly being observed because of advancements in operative mortality rates and the widening of operative indications to include benign diseases such as chronic pancreatitis and intraductal papillary mucinous neoplasm. In this article, we describe a patient diagnosed with intraductal papillary mucinous neoplasm and another with pancreatic cancer, both of whom developed jaundice after undergoing the Whipple procedure. Subsequent investigation revealed a benign hepaticojejunostomy anastomotic stricture, successfully treated with stricturoplasty using a needle knife.

[Application of the holism of body-qi-spirit in needle knife treatment for cervical vertigo].

This paper introduces Professor WANG Haidong's approach to treat cervical vertigo with needle knife based on the holism of body-qi-spirit. Professor WANG Haidong, considering the etiology and pathogenesis of cervical vertigo, starting from the holism of body-qi-spirit, based on the anatomical structure, employs the "seven-neck points" technique to improve local blood supply and address the physical issue; guided by the Jingjin theory, he utilizes the "knot releasing technique" to disperse knots and relax sinews, thereby regulating qi. In addition, he uses the "bone puncturing technique at governor vessel" to uplift yang-qi and nourish the brain, thereby nurturing the spirit.

Analysis of Research Trends in Ultrasound-Guided Acupuncture and Dry-Needling: A Scoping Review.

Background: This study aimed to summarize the current status of research on ultrasound-guided acupuncture and dry-needling treatment and the specific treatment methods applied to patients. Methods: A scoping review was conducted, surveying three English databases (PubMed, Embase, and the Cochrane Library) for studies published up to May 2024. All studies related to ultrasound-guided acupuncture and dry-needling treatment were considered. Literature was selected using selection and exclusion criteria, and extracted and organized using EndNote. Results: A total of 107 eligible studies were included. Among the 107 studies, non-comparative studies accounted for the largest proportion (n = 47, 43.9%), followed by randomized controlled trials (RCTs; n = 41, 38.3%). Diseases of the musculoskeletal system or connective tissue (15 diseases of the musculoskeletal system or connective tissue) accounted for most (n = 48, 55.8%) of the 86 diseases studied, followed by symptoms, signs, or clinical conditions not otherwise classified (n = 17, 19.8%). Conclusions: Ultrasound-guided acupuncture and dry-needling have been actively studied and applied for the treatment of various diseases. However, higher-quality studies are needed for further applications in research and clinical practice.

Effectiveness of acupuncture therapy on improvement of nasolabial folds and marionette lines: A retrospective study.

Background and Aims: The preference of beauty seekers for noninvasive, convenient, and long-lasting effective facial cosmetic techniques with minimal downtime and recovery time is obvious nowadays. As a part of traditional Chinese medicine, acupuncture has great advantages in solving these problems. This study aims to assess the effectiveness of two distinct acupuncture techniques for facial rejuvenation in treating nasolabial folds (NFs) and marionette lines (MLs). Methods: One hundred beauty seekers who have received facial acupuncture cosmetic treatment in hospitals between June 1, 2020, and December 31, 2022, were selected randomly and inquired. Among them, 50 beauty seekers (Group Ⅰ) have received a normal facial traditional Chinese medicine acupuncture therapy, by inserting the needles perpendicularly into the acupoints. Meanwhile, another 50 beauty seekers (Group Ⅱ) were treated by needle knives, which were inserted parallelly under the dermis and basically along the meridians of Chinese medicine linked by the acupoints. The records of pain evaluation and adverse events on cases, subjective satisfactions, and objective evaluations of efficacy were summarized and statistically analyzed. Results: The efficacy of Group Ⅱ is better than Group Ⅰ. The dermatologists' assessments for NF and ML show significant differences between Groups Ⅰ and Ⅱ after one course. The mean value of subjective satisfaction also obeys the rules above. Although Group Ⅱ exhibited the highest value of mean pain intensity, the adverse events were basically mild. Furthermore, Group Ⅱ showed higher willingness for additional treatments. Conclusion: Only in terms of the wrinkle depth of NF and ML, the method of acupuncturing parallelly under the dermis by needle knife is safe and more successful.

Combination of Precut Techniques in Difficult Biliary Cannulation.

Background: Selective biliary cannulation (SBC) is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP). SBC has the potential to fail in as many as 20% of cases, even with skilled endoscopists. Precut incision techniques like needle-knife sphincterotomy (NKS) and transpancreatic septotomy (TPS) can be used in cases where standard cannulation techniques fail. However, these precut techniques may also fail in some cases. We aimed to evaluate the procedural success of the combined TPS + NKS technique in difficult biliary cannulation. Patients and methods: The study included 289 patients who underwent ERCP with precut techniques from 2017 to 2022. Patients were classified into the following three groups and evaluated retrospectively in terms of cannulation success, and ERCP-related adverse effects: Transpancreatic septotomy, NKS, and TPS + NKS; statistical package for the social sciences (SPSS), version 29.0, software was used to analyze the data. Results: The success rate of SBC was 69% in the TPS group, 75.3% in the NCS group, and 87% in the TPS + NCS group. There was no significant difference between the NKS and TPS + NKS groups. Cannulation success in both NKS group and NKS + TPS groups was significantly higher than in the TPS group (p < 0.001). Complication rates were similar. Conclusion: In cases where standard sphincterotomy and precut techniques fail, a second precut technique can be used. A previous TPS does not prevent NKS. How to cite this article: Abiyev A, Tuzcu B, Bilican G, et al. Combination of Precut Techniques in Difficult Biliary Cannulation. Euroasian J Hepato-Gastroenterol 2024;14(1):56-59.

Needle-Knife Fistulotomy Versus Needle-Knife Papillotomy in Difficult Biliary Cannulation: A Systematic Review and Meta-Analysis.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential endoscopic therapeutic modality for biliary and pancreatic diseases. Needle-knife fistulotomy (NKF) and papillotomy (NKP) are the two most commonly used rescue techniques for patients with difficult biliary cannulation. However, there remains a need for comparative studies on these approaches to inform clinical decision-making. This meta-analysis aimed to evaluate the efficacy and safety of NKF compared to NKP as a rescue technique in difficult biliary cannulation after failed conventional ERCP. Methods: We searched PubMed, Scopus, Embase, and Web of Science databases through November 2023 to include all studies that directly compared the outcomes of NKF with NKP in difficult biliary cannulation. Single-arm studies were excluded. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous data related to clinical events were calculated using the Mantel-Haenszel method within a random-effect model. The primary outcome was the biliary cannulation success rate. Results: Four studies with 823 patients (n = 376 NKF vs. n = 447 NKP) were included in our analysis. There was no significant difference between the two groups in biliary cannulation success rate (91.7% vs. 86.9%, respectively; OR = 1.54, 95% CI: 0.21 - 2.49, P = 0.14; I2 = 0%). However, the overall rate of adverse events was significantly lower in the NKF group than in the NKP group (OR = 0.46, 95% CI: 0.25 - 0.84, P = 0.01). Pancreatitis (OR = 0.23, 95% CI: 0.05 - 1.11, P = 0.07) and bleeding (OR = 1.43, 95% CI: 0.59 - 3.46, P = 0.42) were similar between the two groups. No significant differences in cholangitis, cholecystitis, perforation, or mortality were observed. Conclusions: Our meta-analysis indicates comparable success rates in comparing NKF and NKP techniques for difficult biliary cannulation after failed conventional ERCP cannulation. Notably, the NKF technique significantly reduces overall adverse events compared to NKP, suggesting that NKF may be preferable due to its favorable safety profile. Additional randomized controlled trials (RCTs) are warranted to evaluate the interval benefit of an NKF technique.

Analysis of the Effectiveness of Second Attempt Endoscopic Retrograde Cholangiopancreatography (ERCP) 24 Hours (Second Day) After Primary Failure.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive intervention that has established itself as the gold standard therapeutic option for various pancreaticobiliary conditions. Deep cannulation of the common bile duct (CBD) is essential in ERCP. However, cannulation is not possible in approximately 20% of the cases with the usual techniques even when performed by highly trained professionals or at major healthcare institutions. In case of failure on the first attempt, alternative choices include redoing the procedure (on the second attempt) or moving on to more proficient endoscopic methods such as endoscopic ultrasound (EUS) or radiology-aided techniques (rendezvous procedures), totally percutaneous approaches, or surgical treatments. OBJECTIVE: To analyze the effectiveness of the second attempt ERCP 24 hours (second day) after primary failure. METHODOLOGY: This analytical study was conducted to check the outcomes of second attempt ERCP in patients with prior failed cannulation, from June 20, 2023, to November 20, 2023, at the Department of Gastroenterology, Lady Reading Hospital, Peshawar. Patients of either sex, aged >16 years with failed biliary cannulation, and who were otherwise clinically stable were included in the study. Patients with surgically modified anatomy, an unidentified main duodenal papilla, or a history of sphincterotomy at another setup were excluded. Outcomes were assessed in terms of gaining deep biliary access (cannulation) using a therapeutic duodenoscope and endoscopy system supported by a fluoroscope while using a wire-guided sphincterotome. Factors linked to second ERCP cannulation success or failure were analyzed using SPSS version 24. RESULTS: Ninety-four patients were enrolled including 61 (64.9%) males and 33 (35.10%) females. The mean age of the participants was 39.01±14.831 years. The most common indication for the intervention was CBD stones, which were present in 70 (74.5%) patients. Successful cannulation on the second attempt was achieved in 72 (76.6%) patients. Experienced endoscopists achieved a greater proportion of successful cannulation (86.8%) compared to 33.3% by endoscopists with lower experience (p-value: <0.001). Logistic regression analysis was conducted to predict the outcomes (cannulation), which revealed an odds ratio for endoscopist experience of 33.604 (95% confidence interval: 6.948-162.52). CONCLUSION: A second ERCP attempt 24 hours after the primary failed attempt appears to be the best course of action for the majority of clinically stable patients.

Impact of duodenal papilla anatomy on needle knife papillotomy safety and efficacy in patients with difficult biliary canulation.

BACKGROUND AND AIMS: Needle-knife papillotomy (NKP) is widely performed when biliary cannulation is difficult during endoscopic retrograde cholangiopancreatography (ERCP). However, its safety and efficacy in different types of duodenal papilla are not clear. PATIENTS AND METHODS: This retrospective study analyzed 217 patients with difficult biliary cannulation who underwent NKP during ERCP procedures from June 2013 to May 2022 in our institution. Patients were classified according to Haraldsson classification type of duodenal papilla: type 1, regular; type 2, small; type 3, protruding or pendulous; and type 4, creased or ridged. Outcome measures were successful biliary cannulation and incidence of adverse events. RESULTS: Haraldsson classification was type 1 in 115 patients, type 2 in 29, type 3 in 52, and type 4 in 21. Biliary cannulation was successful in 166 patients (76.5%) Success rates according to Haraldsson type were as follows: type 1, 74.8%; type 2, 82.8%; type 3, 80.8%; and type 4, 66.7%. The rates did not significantly differ among the types (p = 0.48). Overall incidence of adverse events was 9.22%. Incidence of adverse events did not significantly differ among the types (p = 0.69). CONCLUSIONS: NKP was useful to achieve successful cannulation in patients with difficult biliary cannulation. The rate of successful cannulation and incidence of adverse events were similar among the different types of duodenal papilla.

Small needle-knife versus extracorporeal shock wave therapy for the treatment of plantar fasciitis: A systematic review and meta-analysis.

Background: Plantar fasciitis (PF) is the most common cause of chronic heel pain among adults. Extracorporeal shock wave therapy (ESWT) is the recommended in the current guidelines, and the small needle-knife yields acceptable clinical effects for musculoskeletal pain. Objective: To systematically compare the efficacy of the small needle-knife versus ESWT for the treatment of PF. Methods: The present review was registered in the International Prospective Register of Systematic Reviews (i.e., "PROSPERO", CRD42023448813). Two of the authors searched electronic databases for randomized controlled trials (RCTs) comparing the small needle-knife versus ESWT for the treatment of PF, and collected outcomes including curative effect, pain intensity, and function. Risk of bias was assessed using the Cochrane Handbook Risk of Bias tool and the quality of the RCTs was evaluated according to the Jadad Scale. The same authors independently performed data extraction from the included studies, which were imported into Review Manager version 5.4.1(Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2020) for meta-analysis. Results: The initial literature search retrieved 886 studies, of which 6 were eventually included in this study. Meta-analysis revealed no significant difference in curative effect (OR = 1.87; 95 % CI [0.80, 4.37], p = .15) nor short-term pain improvement (MD = 2.20; 95 % CI [-2.77, 7.16], p = .39) between the small needle-knife and ESWT. However, the small needle-knife may be more effective than ESWT for pain improvement in mid-term (MD = 9.11; 95 % CI [5.08, 13.15], p＜ .00001) and long-term follow-ups (MD = 10.71; 95 % CI [2.18, 19.25], p＜ .00001). Subgroup analysis revealed that the small needle-knife combined with a corticosteroid injection yielded a statistically significant difference in reduction of pain intensity at all follow-ups (MD = 4.84; 95 % CI [1.33, 8.36], p = .007; MD = 10.99; 95 % CI [8.30, 13.69], p＜ .00001; MD = 17.87; 95 % CI [15.26, 20.48], p＜ .00001). Meta-analysis revealed no statistical differences in short-term (MD = 1.34; 95 % CI [-3.19, 5.86], p = .56) and mid-term (MD = 2.75; 95 % CI [-1.21, 6.72], p = . 17) functional improvement between the needle-knife and ESWT groups. In a subgroup analysis of moderate-quality studies, the small needle-knife demonstrated a favorable effect on mid-term functional improvement (MD = 1.58; 95 % CI [0.52, 2.65], p = .004), with low heterogeneity (χ2 = 0.77, p = .038, I2 = 0 %). Conclusion: Pain reduction and functional improvement are essential for the treatment of PF. Therefore, treatment using the small needle-knife may be superior to ESWT. Results of this systematic review and meta-analysis may provide alternative treatment options for patients with PF as well as more reliable, evidence-based recommendations supporting use of the small needle-knife.

A Cotton Rope in the Colon: A Rare Cause of Chronic Abdominal Pain.

Retained surgical sponge is a relatively rare medical condition with potential serious medicolegal implications. The term "gossypiboma" is frequently used to describe this condition. We present a case of a 40-cm-long retained surgical sponge in a 43-year-old woman who presented with unexplained chronic abdominal pain for several years. She had a history of open cholecystectomy, hepaticojejunostomy, and enteroenterostomy. Computed tomography scan revealed a large cotton sponge anchored within the large bowel. Surgical exploration is usually required for the retrieval of gossypiboma. However, it was successfully removed endoscopically using a diathermic needle knife with no immediate complications. The patient was discharged after 48 hours with marked improvement in her abdominal pain. This case emphasizes the emerging role of novel endoscopic interventions, resulting in excellent clinical outcomes, avoiding major surgical interventions, and providing cost-effective benefits.

Case report: Ultrasound-guided needle knife technique for carpal ligament release in carpal tunnel syndrome treatment.

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy of the hand, mainly manifesting as sensory disturbances, motor dysfunctions, and pain in the fingers and hand. The pathogenesis of the disease is associated with fibrosis of the transverse carpal ligament in the carpal tunnel, which compresses median nerve. In our case, we demonstrate an ultrasound-guided needle knife technique to treat CTS. We guided the patient to a supine position on the examination table. The skin of the wrist area was sterilized for the procedure. After the skin was dry, we positioned sterile drapes, located the median nerve and compression, and marked the compression point. Local anesthesia was administered. An ultrasound-guided needle knife was inserted. The needle knife was advanced under ultrasound guidance. The carpal ligament was incised. A gradual release of pressure on the median nerve was observed on the ultrasound monitor. After treatment, the patient's finger sensation and motor function can significantly improve, and pain symptoms are markedly reduced, this case demonstrates that small needle-knife treatment can serve as a safe and effective minimally invasive therapeutic method.

An innovation percutaneous needle knife use for trigger finger: A retrospective cohort study.

Objectives: This study retrospectively evaluated the effectiveness of percutaneous pulley release by our newly designed needle knife in terms of cure, relapse, and complication rates. Materials and Methods: Two hundred and fifty-seven patients were allocated into male and female groups between October 2014 and September 2021. We included patients >15 years of age with a trigger finger (TF) (types II-VI). The primary outcome was the absence of a TF and pain-free movement. In contrast, the secondary outcome included second-time surgery and the number of complications such as infection and admission for antibiotics. Results: One hundred patients were male, and 157 patients were female. Males and females had mean ages of 62.45 ± 11.76 and 61.50 ± 8.57 years, respectively. The operative time was significantly longer in males than in females (7.88 ± 6.02 vs. 6.52 ± 3.74 min in males and females, respectively, P = 0.027). However, the percentages of diabetes mellitus and gout were the same in both groups. For the percutaneous methods with our needle knife, remission of the trigger was achieved in all cases. In addition, seven patients received revision and three patients with complications. After needle surgery, topical and joint pain scores were improved in both groups (from 5.09 ± 1.31 to 0.80 ± 1.56). Conclusion: The percutaneous methods with our needle knife displayed effectiveness. The cure rate was high, and the relapse rate was low. Further large-scale clinical trials comparing percutaneous needle to open surgery for releasing the TF will be needed to confirm our results.

[Application of "Sancai principle" for needle-knife treatment of bi syndrome of neck region].

Under the guidance of the "Sancai principle", based on the understanding of the etiology and pathogenesis of the imbalance of muscles and bones in bi syndrome of neck region, holistic treatment should be used. The needle-knife release therapy is applied at corresponding acupoints in the three parts i.e. head, neck and back including Tiancai points (Naohu [GV 17] and Naokong [GB 19]), Rencai points (neck Jiaji [EX-B 2]), and Dicai points (Dazhui [GV 14], Quyuan [SI 13] and Tianzong [SI 11]). According to the layers of the lesion's meridians and muscles, the needle-knife is inserted into skin, muscle and bone to relax the tendons and treat bone disorders, and restore the normal mechanical balance of neck.

Does early application of needle-knife sphincterotomy (NKS) in patients with difficult biliary cannulation increase the risk of postERCP pancreatitis? A single centre study.

Objective: To determine that early needle-knife sphincterotomy does not increase post-ERCP pancreatitis in patients with difficult biliary cannulation as compared to standard cannulation. Method: This prospective single-centre cohort study was carried out at Pak Emirates Military Hospital from January 2021 to June 2021. Patients requiring ERCP were enrolled in the study (according to inclusion and exclusion criteria) and were subsequently allotted different groups according to the technique used for deep biliary cannulation. Qualitative data was analysed using frequencies and chi square statistics whereas, quantitative data was analysed using mean±SD and one way ANOVA test. Result: The cohort included 114 patients with 52.6% male patients and predominance of relatively younger age group (31-45 years). The most common indication for ERCP was choledocholithiasis (36%) with an overall technical success rate of 96%. Deep cannulation was achieved either through standard cannulation (56%), double guidewire and/or pancreatic stent assisted (10.5%), use of early Needle-Knife Sphincterotomy (19%), NKS as a last resort (3.5%) or Transpancreatic Stenting and/or combined sphincterotomy (6%). Pancreatitis as a complication occurred in 4(3.5%) patients, bleeding in 2(1.8%), on-table desaturation in 2(1.8%) and perforation in 1(0.9%) patient. The occurrence of pancreatitis was only related significantly to inadvertent PD cannulation through univariate and logistic regression analysis whereas, multiple cannulations (>5), gender, age, classification of papilla and the use of early NKS had no impact on pancreatitis or the occurrence of other complications. Conclusion: NKS is an effective and safe modality for deep biliary cannulation and achieving technical success where cannulation is deemed difficult and does not increase the risk of PEP if done by experienced endoscopists in high volume centres.