title: Comparative analysis of endoscopic precut conventional and needle knife sphincterotomy.
abstract: OBJECTIVE
  To compare the efficacy, complications and post-procedural hyperamylasemia in endoscopic pre-cut conventional and needle knife sphincterotomy.
  
  
  METHODS
  We performed a retrospective analysis of two pre-cut sphincterotomy (PS) techniques, pre-cut conventional sphincterotomy (PCS), and pre-cut needle knife (PNK). The study included 143 patients; the classic technique was used in 59 patients (41.3%), and the needle knife technique was used in 84 patients (58.7%). We analyzed the efficacy of bile duct access, the need for a two-step procedure, the rates of complications and hyperamylasemia 4 h after the procedure, "endoscopic bleeding" and the need for bleeding control. Furthermore, to assess whether the anatomy of the Vater's papilla, indications for the procedure or the need for additional procedures could inform the choice of the PS method, we evaluated the additive hyperamylasemia risk 4 h after the procedure with respect to the above mentioned variables.
  
  
  RESULTS
  The bile duct access efficacy with PNK and PCS was 100% and 96.6%, respectively, and the difference between the two groups was not significant (P = 0.06). However, the needle knife technique required two-step access significantly more often, in 48.8% vs 8.5% of cases (P < 0.0001). The only complication noted was post-ercp pancreatitis (PEP), which was observed in 4/84 (4.8%) and 2/59 (3.4%) patients submitted to PNK and PSC, respectively; the difference between the two procedures was not significant (P = 0.98). An analysis of other consequences of the techniques yielded the following results in the PNK and PCS groups: hyperamylasemia 4 h after the procedure > 80 U/L, 41/84 vs 23/59 (P = 0.32); hyperamylasemia 4 h after the procedure > 240 U/L, 19/84 vs 11/59 (P = 0.71); pancreatic pain, 13/84 vs 7/59 (P = 0.71); endoscopic bleeding, 10/84 vs 8/59 (P = 0.97); and the need for bleeding control, 10/84 vs 7/59 (P = 0.79). In the next part of the study, we analyzed the influence of the method chosen on the risk of hyperamylasemia with respect to an indication for endoscopic retrograde cholangiopancreatography, papillary anatomy and concomitant procedures performed. We determined that the hyperamylasemia risk was increased by more than threefold [odds ratio (OR) = 3.38; P = 0.027] after PCS in patients with a flat Vater's papilla and more than fivefold (OR = 5.3; P = 0.049) after the PNK procedure in patients who required endoscopic homeostasis.
  
  
  CONCLUSIONS
  PCS and PNK do not differ in terms of efficacy or complication rates, but PNK is more often associated with the necessity for a two-step procedure.
authors.affiliation: 2nd Surgical Department, District Hospital Radomska, 27-200 Starachowice, Poland. jamry@tlen.pl
authors.forename: Andrzej
authors.initials: A
authors.lastname: Jamry
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D034321:Hyperamylasemia / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010195:Pancreatitis / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Endoscopic; Endoscopic retrograde cholangiopancreatography; Hyperamylasemia; Sphincterotomy