Failed biliary cannulation occurs in up to 10 % of patients undergoing ERCP.
There is some controversy as to the safety and efficacy of using precut techniques to achieve biliary cannulation in difficult cases.
To date, no randomized trial has compared the success and complication rates of precut with the rates for persistence when biliary cannulation is difficult.
Dr Tang and colleagues undertook a study in order to compare the success rates and complication rates of precut with the success rates and complication rates of persistence in cases of difficult biliary cannulation.
In total, the researchers included 642 patients over a 38-month period.
The investigators screened all patients without prior sphincterotomy who required biliary cannulation.
A “difficult biliary cannulation” was arbitrarily defined as failed cannulation after 12 minutes.
The researchers then randomized these patients to continue treatment either by needle-knife cut over the roof of the papilla or by persistence with a non-wire-guided, single-lumen papillotome.
| Primary success rates and complication rates were similar in the precut and persistence arms|
“Primary” success was defined as deep cannulation within 15 minutes of randomization.
The research team compared primary and final success rates and complication rates within 30 days after ERCP.
The researchers assigned patients in whom biliary cannulation was successful within a time period of 12 minutes or less to a reference group (n = 580).
The research team randomly assigned the remainder of the patients to the “precut” arm (n = 32) or to the “persistence” arm (n = 30).
The researchers found that the primary success rates and complication rates were similar in the precut and persistence arms (75 % and 4 % respectively for the precut arm vs. 73 % and 9 % for the persistence arm).
The team noted that the final successful cannulation rate in the entire group of 642 patients was 99.5 %.
Dr Tangf concluded, "In experienced hands, precut papillotomy and persistence in cannulation are equally effective in cases of difficult cannulation, with a similar complication rate."