title: Long-term experience with the transpancreatic sphincter pre-cut approach to biliary sphincterotomy.
abstract: BACKGROUND
  The transpancreatic duct pre-cut to gain access to the bile duct for diagnostic and therapeutic maneuvers has been described as useful, but questions of efficacy and safety remain to be resolved.
  
  
  METHODS
  To further evaluate this technique, we performed a review on 200 consecutive endoscopic sphincterotomies. Standard direct biliary sphincterotomy was performed in 143 patients and transpancreatic duct pre-cut in 51 patients.
  
  
  RESULTS
  The overall complication rate for the standard sphincterotomy was 2.1%; that for the transpancreatic approach was 1.96%. There were no cases of post-ERCP pancreatitis after transpancreatic duct pre-cut sphincterotomy. The length of hospital stay was 1 day or less for 192 patients, 2 days for 5 patients, 4 days for 1 patient and 7 days for 2 patients. In 2 patients there was failure to enter the bile duct despite the pre-cut. In one, the procedure was successful at a second attempt 48 hours later.
  
  
  CONCLUSIONS
  Transpancreatic duct pre-cut is a safe and effective method for gaining quick access to the bile duct in patients in whom cannulation is difficult.
authors.affiliation: University of Colorado Health Sciences Center, Department of Gastroenterology, Denver, Colorado, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Goff
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D009803:Sphincter of Oddi / Q000000981:diagnostic imaging / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors