Endoscopic precut sphincterotomy for cannulation of inaccessible common bile duct： transpancreatic septum precut versus needle-knife

Abstract

Objective To evaluate the technique of transpancreatic septum precut for cannulation of inaccessible common bile duct in endoscopic retrograde cholangiopancreatography （ERCP）. Methods Data of 109 patients with difficult biliary cannulation in ERCP, of whom 56 underwent transpancreatic septum precut and 53 had needle-knife sphincterotomy from January 2006 to July 2008, were analyzed retrospectively, and the success rate of cannulation and the occurrence of complications were compared between the two methods. Results Of 109 patients accepted precut papillotomy, common bile duct cannulation was successfully achieved in 97. The success rates of transpancreatic septum precut group and needle-knife sphincterotomy group were 96. 4% （54/56） and 81.1% （43/53） respectively, which was significantly different （ P 〈 0.05 ）. Complications occurred in 11 cases, including bleeding（ n = 4）, acute pancreatitis （ n = 5 ）, cholangitis（n = 2 ）. The tolal frequency of complications of the transpancreatic septum pre-cut papillotomy group was lower than that of needle-knife sphincterotomy group（3.6% vs. 17. 0% , P 〈 0. 05 ）. Conclusion In patients with inaccessible bile ducts, transpancreatic septum precut is a safe and effective procedure in cannulation, exhibiting a higher success rate and lower occurrence of complication when compared with needleknife sphincterotomy. Key words: Cholangiopancreatography, endoscopic retrograde ; Common bile duct ; Precut ; Septnm ; Postoperative complications