title: Precut papillotomy: a risky technique not only for experts but also for average endoscopists skilled in ERCP.
abstract: OBJECTIVE
  To evaluate the success and complication rates of early precut papillotomy in difficult biliary cannulations performed by an average endoscopist skilled in ERCP.
  
  
  METHODS
  We studied 146 consecutive ERCPs during a 27-month period. Precutting was instituted if cannulation failed after 10-15 min. Standard papillotomy was performed in the rest. The analysis was divided into initial period (1st year) and subsequent period (following 15 months).
  
  
  RESULTS
  The success rate of cannulation was 95% (139/146). Standard papillotomy was performed in 103/146 (71%) patients. In the remainder, cannulation was successful after precutting in 36/43 (84%) patients. The complication rate was 10% (8/103 in the standard vs. 7/43 in the precut group, P = 0.14). All complications of the standard group were mild. In the precut group, there were three moderate to severe complications. There were no differences between the two periods.
  
  
  CONCLUSIONS
  Precut papillotomy can be an effective and relatively safe procedure when performed by an average endoscopist skilled in ERCP. Although the complication rate of precutting tended to be higher than standard papilotomy, this was reasonable since it increased the success of selective biliary cannulation in 25% of cases. Complication rates did not improve with experience.
authors.affiliation: Gastroenterology Department, University of the State of Rio de Janeiro, 1703 Humaitá, Rio de Janeiro 22261-001, Brazil. faff@gbl.com.br
authors.forename: Fátima A F
authors.initials: FA
authors.lastname: Figueiredo
authors.forename: Alexandre Dias
authors.initials: AD
authors.lastname: Pelosi
authors.forename: Lílian
authors.initials: L
authors.lastname: Machado
authors.forename: Ellen
authors.initials: E
authors.lastname: Francioni
authors.forename: Glaucia
authors.initials: G
authors.lastname: Freitas
authors.forename: Priscila Barbi
authors.initials: PB
authors.lastname: Hatum
authors.forename: Renata
authors.initials: R
authors.lastname: de Mello Perez
mesh_terms: D002404:Catheterization / Q000379:methods*; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome