title: Prospective evaluation of pancreatic sphincterotomy as a precut technique for biliary cannulation.
abstract: OBJECTIVE
  Pancreatic sphincterotomy has been described as an effective technique to obtain biliary access after standard methods fail. This prospective study evaluates its efficacy and compares its complication rate to conventional biliary sphincterotomy (BS).
  
  
  METHODS
  Between January 2001 and January 2004, patients in whom biliary cannulation failed underwent a pancreatic precut sphincterotomy (PPS) and were analyzed prospectively. Multivariate analysis was performed on the following variables with regard to their ability to predict successful biliary cannulation: age, gender, time to access bile duct after precut (< or =10 or >10 minutes), final diagnosis, and operator. Complications of PPS were then compared with those resulting from endoscopic retrograde cholangiopancreatography with BS in 120 patients examined during the same period of time and matched by sex, gender, and disease process.
  
  
  RESULTS
  One hundred sixteen patients (50 male), mean age 58 +/- 16 years, underwent PPS. Immediate biliary access was achieved after pancreatic precut in 99 cases (85%). Complications occurred in 14 patients (12%): 3 (2.6%) postsphincterotomy bleeding, 9 (8%) pancreatitis (8 mild, 1 moderate), and 2 (1.7%) retroperitoneal perforation managed conservatively. The factor statistically associated with successful biliary cannulation was the amount of elapsed time between completing the PPS and obtaining biliary access. No statistical difference was identified in the complication rate of pancreatitis between the PPS and BS groups.
  
  
  CONCLUSIONS
  PPS is an effective precut technique to facilitate biliary cannulation. Success is correlated to the speed of biliary access after precut. In expert hands, its rate of pancreatitis is similar to endoscopic retrograde cholangiopancreatography with BS.
authors.affiliation: Digestive Health Center of Excellence, University of Virginia Health System, Charlottesville, Virginia 22908-0708, USA. mk5ke@virginia.edu
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tokar
authors.forename: Tarun
authors.initials: T
authors.lastname: Mullick
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bickston
authors.forename: Paul
authors.initials: P
authors.lastname: Yeaton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010179:Pancreas / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D009803:Sphincter of Oddi / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*