Precut is a well-known technique that is used if repeated attempts at common bile duct cannulation fail.
However, opinions on the complication rate of precut are conflicting.
Dr de Weerth and colleagues from Germany evaluated the efficacy and complication rate of precut used as a primary method of common bile duct access.
The researchers compared this with the efficacy and safety of the conventional technique during a 19-month study period.
The team evaluated consecutive patients who were scheduled for first-time endoscopic sphincterotomy for a variety of biliary disorders.
The researchers randomized 291 patients were randomized into 2 groups.
The team reported that 146 patients in Group 1 underwent conventional wire-guided biliary cannulation followed by endoscopic sphincterotomy.
|The success rate using a primary precut was 100%|
The team evaluated 145 patients in Group 2 using precut as a primary technique to gain biliary access, followed by wire-guided endoscopic sphincterotomy.
The researchers applied a specially designed, modified Erlangen type of sphincterotome for precutting.
The indications for endoscopic sphincterotomy were comparable in the 2 groups.
In Group 1, the team found that wire-guided cannulation of the common bile duct failed in 42 patients.
Secondary precut was successful in 41 of these patients, leading to an overall success rate of 99%.
In Group 2, the team noted that endoscopic sphincterotomy success rate using primary precut was 100% at the first attempt.
The researchers observed that the mean time to successful deep common bile duct cannulation was 8 minutes in Group 1.
In addition, the team found that the mean time to successful deep common bile duct cannulation was 7 minutes in Group 2.
The incidence of mild to moderate pancreatitis was similar in the 2 groups.
Mild bleeding occurred in only 1 patient and this was controlled by epinephrine injection.
The team reported that none of the study patients developed severe pancreatitis or perforation.
Dr de Weerth's team concluded, “In experienced hands, an approach using primary precut appears to be at least as successful and safe as a conventional approach using guide-wire-based common bile duct cannulation followed by endoscopic sphincterotomy, and might also be a quicker method.”