title: Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation.
abstract: BACKGROUND
  Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation falls have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting.
  
  
  METHODS
  Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm.
  
  
  RESULTS
  Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-pre-cut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (pre-cut, 2.4%, non-pre-cut, 3.9%; p > 0.05).
  
  
  CONCLUSIONS
  Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.
authors.affiliation: Department of Endoscopic Surgery, University Hospital Hamburg, Germany.
authors.forename: K F
authors.initials: KF
authors.lastname: Binmoeller
authors.forename: H
authors.initials: H
authors.lastname: Seifert
authors.forename: H
authors.initials: H
authors.lastname: Gerke
authors.forename: U
authors.initials: U
authors.lastname: Seitz
authors.forename: M
authors.initials: M
authors.lastname: Portis
authors.forename: N
authors.initials: N
authors.lastname: Soehendra
mesh_terms: D000368:Aged; D000465:Algorithms; D014670:Ampulla of Vater / Q000601:surgery*; D001649:Bile Duct Diseases / Q000601:surgery; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002769:Cholelithiasis / Q000601:surgery; D002779:Cholestasis / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000601:surgery; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation* / Q000379:methods; D013525:Surgical Instruments