title: An analysis of the efficacy and safety of a strategy of early precut for biliary access during difficult endoscopic retrograde cholangiopancreatography in a general hospital.
abstract: OBJECTIVE
  The use of early precut during endoscopic retrograde cholangiopancreatography (ERCP) is controversial because of its association with a higher risk of complications. This study examined the efficacy and safety of a strategy of early precut for biliary access during difficult ERCP in a general hospital.
  
  
  METHODS
  Data from January 2007 to June 2009 were reviewed. Criteria for performing early precut were: (i) inadvertent guidewire cannulation of pancreatic duct on three occasions; (ii) biliary stone impacted at papilla; (iii) inability to achieve deep cannulation within 10 min. Study exclusion criteria were: (i) the inability to visualize the papilla because of anatomical distortions; (ii) complete tumour occlusion of distal bile duct; (iii) failure to adhere to inclusion criteria. The efficacy and safety of this strategy of early precut for biliary access was analyzed.
  
  
  RESULTS
  A total of 765 ERCP cases were analyzed. A precut was performed in 55 out of 765 cases (7.2%). There were no significant differences in terms of age, gender and diagnoses between the precut and no precut groups. After precut immediate biliary cannulation was achieved in 89% of patients and this increased to 98.2% with a repeat ERCP. The overall complication rate after ERCP was 2.1% (bleeding: 0.7%; pancreatitis: 1.3%; perforation: 0.3%). The only complication after the precut was pancreatitis, and this was not significantly different from the group without a precut (1.8 vs 1.3%).
  
  
  CONCLUSIONS
  The strategy of early precut for biliary access was safe and effective.
authors.affiliation: Department of Gastroenterology, Changi General Hospital, Singapore. tiing_leong_ang@cgh.com.sg
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Andrew Boon Eu
authors.initials: AB
authors.lastname: Kwek
authors.forename: Kieron Boon Leng
authors.initials: KB
authors.lastname: Lim
authors.forename: Eng Kiong
authors.initials: EK
authors.lastname: Teo
authors.forename: Kwong Ming
authors.initials: KM
authors.lastname: Fock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged