title: Timing of precut procedure does not influence success rate and complications of ERCP procedure: a prospective randomized comparative study.
abstract: BACKGROUND
  There is scarce information on whether performing the precut procedure early rather than after several cannulation attempts is associated with different success and complication rates.
  
  
  OBJECTIVE
  To compare the success and complication rates of precutting implemented either early or after prolonged attempts by the standard approach.
  
  
  METHODS
  Single-center prospective randomized study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Over the 2-year study period, 1078 therapeutic ERCP procedures were performed. One hundred forty-six patients (mean age 68.5 years [range: 34-88 years], 67 men and 79 women) met the selection criteria and were randomized into 2 groups (on a 1:3 basis): group A underwent precut immediately after randomization (36 patients) and group B underwent standard cannulation attempts for a further 20 minutes followed by needle-knife precut in case of failure (110 patients).
  
  
  METHODS
  Deep biliary cannulation and the incidence of post-ERCP complications.
  
  
  RESULTS
  The precut procedure performed in group A allowed deep cannulation of the common bile duct in 33 of 36 patients (92%). In group B, cannulation was successfully achieved in 104 of 110 patients (95%). Among group B patients, biliary cannulation was achieved with the standard approach in 78 patients, whereas precutting was performed in 32 patients, and deep cannulation was achieved in 26 of them. The overall complication rate was 8% (3/36) in group A and 6% (7/110) in group B.
  
  
  CONCLUSIONS
  Small sample size.
  
  
  CONCLUSIONS
  Timing of pre-cutting does not appear to influence success and complication rates of ERCP procedures.
authors.affiliation: Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cennamo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fuccio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Carlo
authors.initials: C
authors.lastname: Fabbri
authors.forename: Diego
authors.initials: D
authors.lastname: Grilli
authors.forename: Massimo
authors.initials: M
authors.lastname: Conio
authors.forename: Nicola
authors.initials: N
authors.lastname: D'Imperio
authors.forename: Franco
authors.initials: F
authors.lastname: Bazzoli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D013997:Time Factors