title: Precut sphincterotomy: efficacy for ductal access and the risk of adverse events.
abstract: BACKGROUND
  Successful ductal access is achieved in 90% of patients who undergo ERCP. Precut sphincterotomy has been advocated when routine cannulation is not possible.
  
  
  OBJECTIVE
  To evaluate the efficacy of precut sphincterotomy for ductal access and the risk of adverse events including post-ERCP pancreatitis (PEP) associated with it.
  
  
  METHODS
  Retrospective analysis of ERCP procedures performed from 2002 to 2011.
  
  
  METHODS
  Referral center.
  
  
  METHODS
  A total of 10,202 consecutive patients who underwent native cannulation ERCP.
  
  
  METHODS
  Efficacy for ductal access and risk of adverse events including PEP.
  
  
  RESULTS
  A total of 706 patients required precut sphincterotomy, 614 of whom (86.9%) had successful biliary cannulation. PEP was diagnosed in 58 (8.2 %), perforation in 6 (0.8%), and bleeding in 49 (6.9%) patients. On multivariate analysis, unsuccessful precut sphincterotomy (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.53-4.40; P < .001) and female sex (OR 1.95; 95% CI, 1.23-3.07; P = .004) were associated with increased risk of the development of adverse events. Female sex (OR 2.42; 95% CI, 1.29-4.55; P = .006) and sphincter of Oddi dysfunction (OR 2.77; 95% CI, 1.16-6.60; P = .02) were associated with an increased risk of PEP.
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Precut sphincterotomy is effective in achieving ductal access when standard cannulation techniques fail. A successful precut sphincterotomy is not associated with an increased risk of adverse events.
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Konjeti
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Vennisvasanth
authors.initials: V
authors.lastname: Lourdusamy
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Dennisdhilak
authors.initials: D
authors.lastname: Lourdusamy
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Mehta
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D003135:Common Bile Duct; D003137:Common Bile Duct Diseases / Q000209:etiology*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D046628:Sphincter of Oddi Dysfunction / Q000150:complications; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects* / Q000379:methods*