Needle-knife sphincterotomy as a precut procedure: a retrospective evaluation of efficacy and complications.
OBJECTIVE
Precut sphincterotomy remains a controversial means of gaining biliary access during endoscopic retrograde cholangiopancreatography (ERCP). This report is a retrospective evaluation of the use of needle-knife sphincterotomy as a precut procedure to achieve biliary access during ERCP.


METHODS
From November 1992 to August 1993, a total of 1071 ERCPs were performed at our institution. During this time, precut sphincterotomy was carried out in 180 patients, with complete follow-up obtained in 178 patients. The follow-up concentrated on the efficacy of the procedure and short-term complications.


RESULTS
Cannulation of the common bile duct was achieved immediately after precut sphincterotomy in 88% of the patients, and during a second ERCP in an additional 11% of patients (total success rate 99%). There were no precut-related deaths. The complication rate of precut sphincterotomy was 21 in 178 (12%). Complications included bleeding in ten patients (5.5%), perforation in four patients (3%), pancreatitis in one patient (0.5%), and fever of unknown origin in six (3%) patients. All complications were managed conservatively.


CONCLUSIONS
Precut sphincterotomy is a safe and highly effective method of gaining biliary access in patients in whom deep cannulation proves difficult or impossible and biliary access is considered essential.
Bruins Slot
W
W
Dept. of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.
Schoeman
M N
MN
Disario
J A
JA
Wolters
F
F
Tytgat
G N
GN
Huibregtse
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct / Q000601:surgery; D004386:Duodenum / Q000293:injuries; D005069:Evaluation Studies as Topic; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009339:Needles; D010195:Pancreatitis / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome