title: Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  There is no clear answer regarding use of precut technique versus conventional method in achieving successful biliary cannulation.
  
  
  OBJECTIVE
  To compare the effectiveness of precut technique with that of conventional biliary cannulation by meta-analysis of available randomized controlled trials (RCTs).
  
  
  METHODS
  Databases including MEDLINE, EMBASE, Cochrane Library, and Science Citation Index updated to July 2009 were searched. Main outcome measures were success rates of biliary cannulation, incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications, and post-ERCP pancreatitis rate. Meta-analysis of these clinical trials was performed.
  
  
  RESULTS
  Six RCTs were included. The primary biliary cannulation rate reported with precut and conventional techniques was 89.3 and 78.1%, respectively. Pooled analysis of all selected studies comparing precut cannulation technique with conventional techniques yielded an odds ratio (OR) of 2.05 [95% confidence interval (CI): 0.64-6.63]. Pooled analysis comparing post-ERCP pancreatitis rates for the precut-cannulation groups with those for the conventional-method groups yielded an rate ratio (RR) of 0.46 (95% CI: 0.23-0.92).
  
  
  CONCLUSIONS
  This meta-analysis shows that the precut technique does not increase the primary cannulation rate. However, the technique reduces the risk of post-ERCP pancreatitis compared with conventional technique. Further large, well-performed, randomized controlled studies are needed to confirm these findings.
authors.affiliation: Digestive Endoscopy Center, Department of Gastroenterology, Runjin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. gb-ercp@vip.sina.com.cn
authors.forename: Biao
authors.initials: B
authors.lastname: Gong
authors.forename: Lixiao
authors.initials: L
authors.lastname: Hao
authors.forename: Like
authors.initials: L
authors.lastname: Bie
authors.forename: Bo
authors.initials: B
authors.lastname: Sun
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
mesh_terms: D001652:Bile Ducts / Q000601:surgery*; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010195:Pancreatitis / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic