title: Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: An updated meta-analysis.
abstract: OBJECTIVE
  To study the cannulation and complication rates of early pre-cut sphincterotomy vs persistent attempts at cannulation by standard approach.
  
  
  METHODS
  Systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Library for relevant studies published up to February 2013. The main outcome measurements were cannulation rates and post-endoscopic retrograde cholangiopancreatography (ERCP) complications. A comprehensive systematic search of the Cochrane library, PubMed, Google scholar, Scopus, National Institutes of Health, meta-register of controlled trials and published proceedings from major Gastroenterology journals and meetings until February 2013 was conducted using keywords. All Prospective randomized controlled trials (RCT) studies which met our inclusion criteria were included in the analysis. Prospective non-randomized studies and retrospective studies were excluded from our meta-analysis. The main outcomes of interest were post-ERCP pancreatitis, overall complication rates including cholangitis, ERCP-related bleeding, perforation and cannulation success rates.
  
  
  RESULTS
  Seven RCTs with a total of 1039 patients were included in the meta-analysis based on selection criteria. The overall cannulation rate was 90% in the pre-cut sphincterotomy vs 86.3% in the persistent attempts group (OR = 1.98; 95%CI: 0.70-5.65). The risk of post-ERCP pancreatitis (PEP) was not different between the two groups (3.9% in the pre-cut sphincterotomy vs 6.1% in the persistent attempts group, OR = 0.58, 95%CI: 0.32-1.05). Similarly, there was no statistically significant difference between the groups for overall complication rate including PEP, cholangitis, bleeding, and perforation (6.2% vs 6.9%, OR = 0.85, 95%CI: 0.51-1.41).
  
  
  CONCLUSIONS
  This meta-analysis suggests that pre-cut sphincterotomy and persistent attempts at cannulation are comparable in terms of overall complication rates. Early pre-cut implementation does not increase PEP complications.
authors.affiliation: Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Konjeti
authors.affiliation: Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Preethi Gk
authors.initials: PG
authors.lastname: Venkatesh
authors.affiliation: Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
keywords: Meta analysis; Persistent attempts; Post-cholangiopancreatography pancreatitis; Pre-cut sphincterotomy