Precut Papillotomy Versus Persistence in Difficult Biliary Cannulation: A Prospective Randomized Trial

Abstract

In experienced hands, precut papillotomy and persistence in cannulation are equally effective in cases of difficult cannulation, with a similar complication rate.

Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

“…The overall biliary cannulation rate higher than 90% obtained in this study was also comparable to other reports from tertiary centers. 3,6,9 When a second ERCP was performed in the primary failures, the overall CBD cannulation improved to more than 96% in both groups. The strategy of performing a second ERCP when an NKF is unsuccessful in the first ERCP was highly effective and safe, as previously reported.…”

“…Because previous studies reported a diversity of outcomes estimates, the number of patients needed to perform a randomized, controlled trial would be difficult to calculate, and a very large number of patients would be needed if we anticipate differences of 5% in terms of adverse event rates and/or cannulation rates and/or time spent on the fistulotomy that was seldom described before. 9 Thus, we decided to simply describe our experience using (as much as possible) standardized procedures prospectively and for the first time address all 3 outcomes combined. Our data could now give more support for a multicenter trial design to increase the evidence of our recommendations, even though it would be an extremely difficult project to implement.…”

“…These criteria either precluded the use of the precut technique (criterion 3) or potentially decreased its technical safety because of anatomic features (criteria 1, 2, and 4). 9 The hospital's ethics committee approved this study, and informed consent was obtained from all patients for the procedure.…”

Endoscopic Needle Knife Precut Papillotomy for Inaccessible Bile Duct following Failed Pancreatic Duct Access

“…8,17,23 Injury of the papilla may be more severe in patients in whom a long duration for cannulation is allowed before the precut papillotomy. Biliary cannulation was successfully performed in 95% of native papilla cases, although a long time period was allowed for standard cannulation before the precut papillotomy.…”

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…51,[86][87][88][89][90][91] Meta-analyses support early precut when compared to ongoing cannulation attempts. [92][93][94] Definition of "early" and the precut technique are other variables.…”