Precut Papillotomy: A Risky Technique Not Only for Experts but Also for Average Endoscopists Skilled in ERCP

Abstract

Precut papillotomy can be an effective and relatively safe procedure when performed by an average endoscopist skilled in ERCP. Although the complication rate of precutting tended to be higher than standard papilotomy, this was reasonable since it increased the success of selective biliary cannulation in 25% of cases. Complication rates did not improve with experience.

Precut Fistulotomy for Difficult Biliary Cannulation: Is It a Risky Preference in Relation to the Experience of an Endoscopist?

“…Requirement for PF was somewhat higher than in previous reports (3.8-19.2%) [7], at 23.1%, because all of the procedures were performed by a junior endoscopist after training. Overall, previously reported successful cannulation rates were 90% and complication rates, considering pancreatitis, bleeding, perforation, and cholangitis were 5-19% in precut fistulotomy [1,2,19,[32][33][34]. In our present study, the overall complications and post-ERCP pancreatitis rates were similar to those reported previously, at 10.7 and 5.7%, respectively, and the overall success rates were also similar, at 93.7%.…”

Transpapillary selective bile duct cannulation technique: Review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004

“…One hundred twenty‐four articles were judged not suitable for pooled analysis based on their abstracts. After vetting was complete, 69 articles were reviewed.…”

Trainee involvement increases precut rates and delays access to the common bile duct without an increase in procedure-related adverse events: a brave new world of ERCP training?

“…It is also worth noting that, despite the change of cannulation technique, the technical success and adverse events rate in our center have remained stable over time, and within the recommended quality standards parameters. Current guidelines recognize a wide variation in the use of precut, ranging from 5% to 31.5% of cases, with contradictory results with regard to the relationship between operator experience and procedure success as well as adverse events rate [1,[20][21][22]. However, most of the evidence cited comes from expert endoscopists working in large referral centers rather than from real-life observational studies.…”