The use of needle knife papillotomy (NKP) to achieve a selective bile duct cannulation is controversial. Despite this, many endoscopy centres have reported successful use of NKP when conventional techniques failed. In this prospective study, we assessed the safety and efficacy of NKP in eighty seven patients. In fifty nine of these patients, cholangiogram had failed and in twenty eight patients endoscopic sphincterotomy was unsuccessful because attempts at selective bile duct cannulation had failed. NKP was found successful in fifty one cases (58.6%) during the initial procedure and overall success rate was 79.3% after the subsequent session. There were complications in four cases (4.6%). There were no procedure related mortality and only two complications required surgical intervention. Based on our results, we consider that NKP is a helpful and safe procedure in patients in whom conventional techniques have failed.