Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis

Abstract

Endocut mode offers a safety advantage over conventional blended cut mode for pancreatitis after EST by reducing hyperamylasemia.

Japan Gastroenterological Endoscopy Society guidelines for endoscopic sphincterotomy

“…In EST, there are four cutting currents including: (i) pure‐cut; (ii) coagulation; (iii) blended (cutting and coagulation); and (iv) proprietary currents which are characterized by an automatically controlled cut system. From the perspective of procedural accidents to date, such as bleeding and perforation, studies comparing the Endocut mode, which is one automatic control function, with cutting wave only, or combined wave have been reported . According to these reports, unexpected sudden cuts (zipper cut) are rare with the Endocut mode; however, there was no significant difference observed between the two modes in perforation, pancreatitis and clinical hemorrhage.…”

“…From the perspective of procedural accidents to date, such as bleeding and perforation, studies comparing the Endocut mode, which is one automatic control function, with cutting wave only, or combined wave have been reported. 16,18,19,[39][40][41][42] According to these reports, unexpected sudden cuts (zipper cut) are rare with the Endocut mode; however, there was no significant difference observed between the two modes in perforation, pancreatitis and clinical hemorrhage. In a meta-analysis of four randomized trials, there was a high incidence of mild bleeding with cutting output only (28.9% vs 9.4%; diff 0.195 CI, 0.123 to 0.379); however, there was no difference observed in pancreatitis (3.8% vs 7.9%, diff -0.041 CI, À0.096 to 0.015), and severe bleeding.…”

A Prospective Randomized Controlled Study of Endoscopic Sphincterotomy With the Endocut Mode or Conventional Blended Cut Mode

“…It is the largest prospective study to date that addresses whether the E-mode can surpass the conventional blended C-mode in the EST procedure. The earlier studies registered a total of 100 and 134 patients, 14 , 17 and they did not perform the power calculations. However, a larger but retrospective study (n=2309) exists.…”

“…However, a larger but retrospective study (n=2309) exists. 18 Another strength is that we restricted our study to one operator, in comparison with the earlier studies, 14 , 17 , 18 except that there was no description in one study. 19 This obviously decreased the bias based on the difference of operator experience.…”

“… 16 As for the comparison of mixed current modes, the results were controversial in the development of acute pancreatitis and clinically significant bleeding in multiple clinical trials comparing the E-mode with the blended C-mode. 14 , 17 – 19 However, the problems in the previous studies, including small sample size and retrospective analysis, make it difficult to conclude the advantage of efficacy and safety of the E-mode. Our study aim was to evaluate whether the E-mode surpasses the conventional blended C-mode in safety and efficacy.…”