Precut papillotomy: a risky technique not only for experts but also for average endoscopists skilled in ERCP.
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.
Figueiredo
Fátima A F
FA
Gastroenterology Department, University of the State of Rio de Janeiro, 1703 Humaitá, Rio de Janeiro 22261-001, Brazil. faff@gbl.com.br
Pelosi
Alexandre Dias
AD
Machado
Lílian
L
Francioni
Ellen
E
Freitas
Glaucia
G
Hatum
Priscila Barbi
PB
de Mello Perez
Renata
R
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