Evaluation of Early Precut with Needle-Knife in Difficult Biliary Cannulation During ERCP

Abstract

There is scarce information on whether performing the precut procedure early rather than after several cannulation attempts is associated with different success and complication rates. The aim of this retrospective study was is to compare the early precut technique with the standard one in terms of the results and complications. The contemporary success rate and postoperative complications in 792 endoscopic retrograde cholangiopancreatography cases were frequently observed during the period from June 2007 to May 2011, and 56 of these cases were carried out with precut biliary sphincterotomy after the standard sphincterotomy had failed. The success rate for standard sphincterotomy was 89.8%: 51 out of 56 cases were carried out with precut biliary sphincterotomy and succeeded. The total success rate was 96.3%. The difference was significant (χ2=25.62, p<0.01) compared to the success rate of first cannulation, while the difference in complication rates between precut and standard sphincterotomy was minor (9.9 vs. 12.5%, p>0.05). Early precut with a needle-knife in a difficult biliary cannulation was safe and effective if performed by experienced endoscopists.