title: First cut, then blend: an electrocautery technique affecting bleeding at sphincterotomy.
abstract: OBJECTIVE
  The use of pure cut electrocautery current for endoscopic sphincterotomy lowers pancreatitis rates following endoscopic retrograde cholangiopancreatography (ERCP), but at the expense of greater localized bleeding which partially obscures the endoscopic view. We hypothesized that localized bleeding could be decreased by using blended current at the end of the sphincterotomy, without losing the benefit associated with pure cut current of lower post-ERCP pancreatitis benefit.
  
  
  METHODS
  Patients undergoing sphincterotomy were randomly allocated to receive pure cut current alone or a sequential combination of pure cut then blended current. In the sequential combination patients, the first 75 - 80 % of the sphincterotomy was done using pure cut current at 30 W and the remainder completed at a blend 2 setting (pure cut plus coagulation current), also at 30 W.
  
  
  RESULTS
  142 patients were enrolled in the study. No statistical difference was noted between the two groups in the rates of overall pancreatitis or bleeding requiring transfusion. When comparing visible bleeding rates (more than a few drops), we found that there was significantly more bleeding (P < 0.05) in the pure cut group (31/75, 41 %) at the time of sphincterotomy compared with the sequential combination group (16/67, 23 %).
  
  
  CONCLUSIONS
  A sequential combination of pure cut and blended current for sphincterotomy caused less visible bleeding than pure cut alone. This occurred without a change in the rate of post-ERCP pancreatitis.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-0362, USA.
authors.forename: A
authors.initials: A
authors.lastname: Gorelick
authors.forename: M
authors.initials: M
authors.lastname: Cannon
authors.forename: J
authors.initials: J
authors.lastname: Barnett
authors.forename: W
authors.initials: W
authors.lastname: Chey
authors.forename: J
authors.initials: J
authors.lastname: Scheiman
authors.forename: G
authors.initials: G
authors.lastname: Elta
mesh_terms: D000208:Acute Disease; D000328:Adult; D001660:Biliary Tract Diseases / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods*