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Early Decision for Precut Sphincterotomy: Is It a Risky Preference?

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Abstract

The aim of this prospective study was to evaluate the results and the complications at a tertiary referral center which frequently uses precutting techniques for biliary cannulation. Four hundred seventy patients with naive papilla for whom biliary intervention was planned were included in the study. If the selective cannulation was not achieved after a few trials, precutting sphincterotomy was performed. The results were evaluated for the frequency, success, and complication rates of precutting. Precutting was performed on 238 (50.6%; 117 male, 121 female; mean age, 58.5±16.2 years) of 470 patients. Total success rate of endoscopic retrograde cholangiopancreatography (ERCP) was 99.2% (236/238). The rate of complications in patients with versus without precutting was 7 (2.9%) versus 3 (1.3%) for pancreatitis, 2 (0.8%) versus 1 (0.4%) for perforation, and 7 (2.9%) versus 3 (1.3%) for bleeding. The differences between the rates were not significant. Early precutting can be preferable in prolonged cannulation trials of therapeutic ERCP.

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References

  1. Huibregtse K, Kimmey MB (1995) Endoscopic retrograde cholangiopancreatography and endoscopic biliary and pancreatic drainage. In: Yamada T (ed). Textbook of gastroenterology. J. P. Lippincott, Philadelphia, pp 2590–2617

    Google Scholar 

  2. Loperfido S, Angelini G, Benedetti G, et al. (1998) Major early complication from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48:1–10

    Article  PubMed  CAS  Google Scholar 

  3. Freeman ML, Nelson DB, Sherman S, et al. (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918

    Article  PubMed  CAS  Google Scholar 

  4. Masci E, Toti G, Mariani A, et al. (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 96:417–423

    Article  PubMed  CAS  Google Scholar 

  5. Nelson DB, Freeman ML (1994) Major hemorrhage from endoscopic sphincterotomy: risk factor analysis. J Clin Gastroenterol 19:283–287

    Article  PubMed  CAS  Google Scholar 

  6. Shakoor T, Geenen JE (1999) Pre-cut papillotomy. Gastrointest Endosc 38:623– 627

    Google Scholar 

  7. Freeman ML (1999) Precut (access) sphincterotomy. Techn Gastrointest Endosc 1:40– 48

    Article  Google Scholar 

  8. Huibregtse K, Katon RM, Tytgat GN (1986) Precut papillotomy via fine needle-knife papillotome:a safe and effective technique. Gastrointest Endosc 32:403– 405

    PubMed  CAS  Google Scholar 

  9. Gholson CF, Favrot D (1996) Needle-knife papillotomy in a university referral practice. Safety and efficacy of a modified technique. J Clin Gastroenterol 23:177–180

    Article  PubMed  CAS  Google Scholar 

  10. Binmoeller KF, Seifert H, Gerke H, et al. (1996) Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve bile duct cannulation. Gastrointest Endosc 44:689–695

    Article  PubMed  CAS  Google Scholar 

  11. Foutch PG (1995) A prospective assessment of results for needle-knife papillotomy and standard endoscopic sphincterotomy. Gastrointest Endosc 41:25–32

    Article  PubMed  CAS  Google Scholar 

  12. Kasmin FE, Cohen D, Batra S, et al. (1996) Needle-knife sphincterotomy in a tertiary referral center: efficacy and complications. Gastrointest Endosc 44:48–53

    Article  PubMed  CAS  Google Scholar 

  13. Slot WB, Schoeman MN, Disario JA, et al. (1996) Needle-knife sphincterotomy as a pre-cut procedure—a retrospective evaluation of efficacy and complications. Endoscopy 28:334– 339

    Google Scholar 

  14. Sherman S, Hawes R, Earle D, et al. (1996) Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy (ES)-induced pancreatitis? A final analysis of a randomized prospective study [abstract]. Gastrointest Endosc 43:413

    Google Scholar 

  15. Cotton PB, Lehman G, Vennes JA, et al. (1991) Endoscopic sphyncterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393

    PubMed  CAS  Google Scholar 

  16. Siegel JH (1980) Precut papillotomy—a method to improve the success of ERCP and papillotomy. Endoscopy 12:130–133

    PubMed  CAS  Google Scholar 

  17. Baillie J (1997) Needle-knife sphincterotomy revisited. Gastrointest Endosc 46:282–284

    PubMed  CAS  Google Scholar 

  18. Sriram PVJ, Rao GV, Nageshwar Reddy D (2003) The precut—When, where and how? A review. Endoscopy 35:24–30

    Article  Google Scholar 

  19. Siegel JH, Ben-Zvi J, Pullano W (1989) The needle knife: a valuable tool in diagnostic and therapeutic ERCP. Gastrointest Endosc 35:499–503

    PubMed  CAS  Google Scholar 

  20. Dowsett JF, Polydorou AA, Vaira D, et al. (1990) Needle-knife sphincterotomy: How safe and how effective? Gut 31:905–908

    PubMed  CAS  Google Scholar 

  21. Rollhauser C, Johnson M, Al-Kawas FH (1998) Needle-knife papillotomy: a helpful and safe adjunct to endoscopic retrograde cholangiopancreatography in a selected population. Endoscopy 30:691–696

    PubMed  CAS  Google Scholar 

  22. Katuscak I, Horakova M, Frlicka P, et al. (1991) Needle-knife sphincterotomy: a necessary tool [Letter, Comment]. Gastrointest Endosc 37:495

    PubMed  CAS  Google Scholar 

  23. Kim HJ, Kim MH, Kim DI, et al. (1999) Endoscopic hemostasis in sphincterotomy-induced hemorrhage:its efficacy and safety. Endoscopy 31:431–436

    Article  PubMed  CAS  Google Scholar 

  24. Enns R, Eloubeidi MA, Mergener K, et al. (2002) ERCP-related perforations: risk factors and management. Endoscopy 34:293–298

    Article  PubMed  CAS  Google Scholar 

  25. Freeman ML (2003) Adverse outcomes of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endoscopy Clin N Am 13:775–798

    Article  Google Scholar 

  26. Freeman ML, DiSario JA, Nelson DB, et al. (2001) Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 54:425–434

    Article  PubMed  CAS  Google Scholar 

  27. Christoforidis E, Goulkimaris I, Kanellos I, et al. (2002) Post-ERCP pancreatitits and hyperamylasemia: patient-related and operative risk factors. Endoscopy 34:286–292

    Article  PubMed  CAS  Google Scholar 

  28. Chen YK, Foliente RL, Santoro MJ, et al. (1994) Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol 89:327–333

    PubMed  CAS  Google Scholar 

  29. Macsi E, Mariani A, Curioni S, et al. (2003) Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy 35:830–834

    Article  Google Scholar 

  30. Maldonado ME, Brady PG, Mamel JJ, et al. (1999) Incidence of pancreatitis in patients undergoing sphincter of Oddi manometry (SOM). Am J Gastroenterol 94:387–390

    Article  PubMed  CAS  Google Scholar 

  31. Mehta SN, Pavone E, Barkun JS, et al. (1998) Predictors of post-ERCP complications in patients with suspected choledocholithiasis. Endoscopy 30:457–463

    PubMed  CAS  Google Scholar 

  32. Rabenstein T, Schneider HT, Bulling D, et al. (2000) Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment. Endoscopy 32:10–19

    Article  PubMed  CAS  Google Scholar 

  33. Testoni PA (2003) Preventing post-ERCP pancreatitis: Where are we? J Pancreas (Online) 4(1):22–32

    Google Scholar 

  34. Tarnasky PR, Palesch YY, Cunningham JT (1998) Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology 115:1518–1524

    Article  PubMed  CAS  Google Scholar 

  35. Fogel EL, Eversman D, Jamidar P, et al. (2002) Sphincter of Oddi dysfunction: pancreaticobiliary sphincterotomy with pancreatic stent placement has a lower rate of pancreatitis than biliary sphincterotomy alone. Endoscopy 34:280–285

    Article  PubMed  CAS  Google Scholar 

  36. Patel R, Tarnasky PR, Hennessy WS, et al. (1999) Does stenting after pancreatic sphincterotomy reduce post-ERCP pancreatitis in patients with prior biliary sphincterotomy? Preliminary results of a prospective, randomized trial. Gastrointest Endosc 49:A80

    Google Scholar 

  37. Aizawa T, Ueno N (2001) Stent placement in the pancreatic duct prevents pancreatitis after endoscopic sphincter dilation for removal of bile duct stones. Gastrointest Endosc 54:209–213

    PubMed  CAS  Google Scholar 

  38. Testoni PA, Bagnolo F, Andriulli A, et al. (2001) Octreotide 24-h prophylaxis in patients at high risk for post-ERCP pancreatitis: results of a multicenter, randomized, controlled trial. Aliment Pharmacol Ther 15:965–972

    Article  PubMed  CAS  Google Scholar 

  39. Bergman JJ, Rauws EA, Fockens P, et al. (1997) Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bile duct stones. Lancet 349:1124–1129

    Article  PubMed  CAS  Google Scholar 

  40. Ochi Y, Mukawa K, Kiyosawa K, et al. (1999) Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones. J Gastroenterol Hepatol 14:90–96

    Article  PubMed  CAS  Google Scholar 

  41. DiSario JA, Freeman ML, Bjorkman DJ, et al. (1997) Endoscopic balloon dilation compared to sphincterotomy (EDES) for extraction of bile duct stones: preliminary results. Gastrointest Endosc 45:AB129

    Article  Google Scholar 

  42. Cotton PB (1989) Precut papillotomy: a risky technique for experts only [Editorial]. Gastrointest Endosc 35:578–579

    PubMed  CAS  Google Scholar 

  43. Vandervoort J, Carr-Locke DL (1996) Needle-knife access papillotomy: An unfairly maligned technique? Endoscopy 28:365–366

    PubMed  CAS  Google Scholar 

  44. Rabenstein T, Roggenbuck S, Framke B, et al. (2002) Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP? Gastrointest Endosc 55:476–483

    Article  PubMed  Google Scholar 

  45. Bruins Slot W, Schoeman MN, Disario JA, et al. (1996) Needle-knife sphincterotomy as a precut procedure: a retrospective evaluation of efficacy and complications. Endoscopy 28:334–339

    Article  PubMed  CAS  Google Scholar 

  46. Tang SJ, Haber GB, Kotran P, et al. (2005) Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy 37:58–65

    Article  PubMed  Google Scholar 

  47. Kaffes AJ, Sriram PVJ, Rao GV, et al. (2005) Early institution of pre-cutting for difficult cannulation: a prospective study comparing conventional vs. a modified technique. Gastrointest Endosc 62:669–674

    Article  PubMed  Google Scholar 

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Parlak, E., Cicek, B., Disibeyaz, S. et al. Early Decision for Precut Sphincterotomy: Is It a Risky Preference?. Dig Dis Sci 52, 845–851 (2007). https://doi.org/10.1007/s10620-006-9546-x

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  • DOI: https://doi.org/10.1007/s10620-006-9546-x

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