title: Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease.
abstract: BACKGROUND
  Repeated attempts at cannulating the papilla of Vater and "needle-knife" precut sphincterotomy are independent risk factors for post-ERCP pancreatitis. Whether precut alone or repeated attempts at cannulation is the culprit factor in the development of post-ERCP pancreatitis remains controversial.
  
  
  OBJECTIVE
  To retrospectively assess the role of precutting and multiple cannulation in the occurrence of post-ERCP pancreatitis in a consecutive series of patients with bile stone disease.
  
  
  METHODS
  2004 patients who had undergone endoscopic retrograde cholangio-pancreatography over a 9-year period for bile stones were evaluated. Pancreatitis rate was assessed in relation to the number of cannulation attempts (<10 and ≥10) and precutting.
  
  
  RESULTS
  Procedures were successful in 1878 patients (93.7%). Cannulation was done without precutting in 1717 cases and with in 161. Pancreatitis occurred in 2.7% of patients who had undergone biliary cannulation without precutting and in 6.5% with (p=0.006). It was lower with <10 attempts than with ≥10 (p<0.0001), either without (p<0.0001) or with precutting (p<0.01). Pancreatitis rate did not differ without and with precutting when <10 attempts at cannulation were done, whilst it was lower when precut was done before 10 attempts than when 10 or more attempts were made without precutting (p=0.02).
  
  
  CONCLUSIONS
  Pancreatitis rate was lower when precut was done with <10 attempts than when ≥10 attempts were made without precutting. In experienced hands precut biliary sphincterotomy does not seem to be an independent risk factor for post-ERCP pancreatitis in patients undergoing endoscopic retrograde cholangio-pancreatography for bile duct stones.
authors: Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Via Olgettina 60, 20132 Milan, Italy. testoni.pieralberto@hsr.it
authors: Pier Alberto
authors: PA
authors: Testoni
authors: Antonella
authors: A
authors: Giussani
authors: Cristian
authors: C
authors: Vailati
authors: Sabrina
authors: S
authors: Testoni
authors: Milena
authors: M
authors: Di Leo
authors: Alberto
authors: A
authors: Mariani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D012189:Retrospective Studies; D009803:Sphincter of Oddi / Q000601:surgery; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects*