title: A randomized trial of endoscopic biliary sphincterotomy using pure-cut versus combined cut and coagulation waveforms.
abstract: OBJECTIVE
  Endoscopic biliary sphincterotomy has complication rates of 5%-12%. The output from the electrosurgical generator may influence the degree of coagulation and the rapidity of the incision, and thus rates of pancreatitis, hemorrhage, and perforation. Some modern generators incorporate feedback control to standardize output and automate the alternating cut and coagulation modes. Our aim was to compare 2 feedback-controlled generators, one with constant pure cutting-type output and the other with an alternating cut and coagulation mode.
  
  
  METHODS
  In this multicenter randomized study, 133 patients were assigned to the alternating cut/coag output and 134 patients were assigned to constant pure-cut output. Patients were stratified by their risk for pancreatitis.
  
  
  RESULTS
  The overall pancreatitis rate was 1.5%, including 3 patients in the cut/coag group and 1 patient in the pure-cut group (P>.05). There were 11 poorly controlled (zipper) incisions in the pure-cut group and none in the cut/coag group (P=.02). The incision was completed in all patients without stalling. Immediate hemorrhage occurred in 35 pure-cut patients and 8 cut/coag patients output (P=.002). There were no episodes of clinically significant bleeding, delayed bleeding, or perforation.
  
  
  CONCLUSIONS
  Biliary sphincterotomy using feedback-controlled generators results in dependable progression of incision with a low pancreatitis rate. Control of the incision is improved subjectively with the cut/coagulation output, but this did not translate into a difference in clinically significant complications.
authors.affiliation: Division of Gastroenterology, Mayo Clinic and College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Norton
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.forename: Jay
authors.initials: J
authors.lastname: Bosco
authors.forename: Doug B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Peter B
authors.initials: PB
authors.lastname: Meier
authors.forename: Todd H
authors.initials: TH
authors.lastname: Baron
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Lange
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
authors.forename: David S
authors.initials: DS
authors.lastname: Loeb
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: Nicole
authors.initials: N
authors.lastname: Pochron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome