Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(07): E830-E841
DOI: 10.1055/a-2325-3821
Review

Pure cut vs. Endocut in endoscopic biliary sphincterotomy: Systematic review and meta-analysis of randomized clinical trials

Luiza Bicudo de Oliveira 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Mateus Pereira Funari 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Angelo So Taa Kum 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Alexandre de Moraes Bestetti
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Vitor Ottoboni Brunaldi 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
2   Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
3   Gastroenterology and Hepatology Division, Mayo Clinic, Rochester, United States (Ringgold ID: RIN6915)
,
Tomazo Antonio Prince Franzini
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Eduardo Turiani Hourneaux Moura
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Luiza Martins Baroni
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Matheus Ferreira de Carvalho
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Wanderley Marques Bernardo 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
,
Eduardo Guimarães Hourneaux de Moura 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Referred to by:

How should the electrosurgical mode be optimized for endoscopic sphincterotomy?Endosc Int Open 2024; 12(11): E1434-E1436
DOI: 10.1055/a-2466-8038

Abstract

Background and study aims Biliary sphincterotomy is a crucial step in endoscopic retrograde cholangiopancreatography (ERCP), a procedure known to carry a 5% to 10% risk of complications. The relationship between Pure cut, Endocut, post-ERCP pancreatitis (PEP) and bleeding is unclear. This systematic review and meta-analysis compared these two current types and their relationships with adverse events.

Patients and methods This systematic review involved searching articles in multiple databases until August 2023 comparing pure cut versus Endocut in biliary sphincterotomy. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

Results A total of 987 patients from four randomized controlled trials were included. Overall pancreatitis: A higher risk of pancreatitis was found in the Endocut group than in the Pure cut group (P=0.001, RD=0.04 [range, 0.01 to 0.06]; I2=29%). Overall immediate bleeding: Statistical significance was found to favor Endocut, (P=0.05; RD=–0.15 [range, –0.29 to –0.00]; I2=93%). No statistical significance between current modes was found in immediate bleeding without endoscopic intervention (P=0.10; RD=–0.13 [range, –0.29 to 0.02]; I2=88%), immediate bleeding with endoscopic intervention (P=0.06; RD=–0.07 [range, –0.14 to 0.00]; I2=76%), delayed bleeding (P=0.40; RD=0.01 [range, –0.02 to 0.05]; I2=72%), zipper cut (P=0.58; RD=–0.03 [range, –0.16 to 0.09]; I2=97%), perforation (P=1.00; RD=0.00 [range, –0.01 to 0.01]; I2=0%) and cholangitis (P=0.77; RD=0.00 [range, –0.01 to 0.02]; I2=29%).

Conclusions The available data in the literature show that Endocut carries an increased risk for PEP and does not prevent delayed or clinically significant bleeding, although it prevents intraprocedural bleeding. Based on such findings, Pure cut should be the preferred electric current mode for biliary sphincterotomy.

Keywords

Pancreatobiliary (ERCP/PTCD) - ERC topics - Stones


Publication History

Received: 22 December 2023

Accepted after revision: 12 April 2024

Accepted Manuscript online:
13 May 2024

Article published online:
03 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Thaker AM, Mosko JD, Berzin TM. Post-endoscopic retrograde cholangiopancreatography pancreatitis. Gastroenterol Rep (Oxf) 2015; 3: 32-40
    CrossrefPubMedSearch in Google Scholar
  • 2 de Clemente Junior CC, Bernardo WM, Franzini TP. et al. Comparison between endoscopic sphincterotomy vs endoscopic sphincterotomy associated with balloon dilation for removal of bile duct stones: A systematic review and meta-analysis based on randomized controlled trial. World J Gastrointest Endosc 2018; 10: 130-144
    CrossrefPubMedSearch in Google Scholar
  • 3 Furuya CK, Sakai P, Marinho FRT. et al. Papillary fistulotomy vs conventional cannulation for endoscopic biliary access: A prospective randomized trial. World J Gastroenterol 2018; 24: 1803-1811
    CrossrefPubMedSearch in Google Scholar
  • 4 Kouanda A, Bayudan A, Hussain A. et al. Current state of biliary cannulation techniques during endoscopic retrograde cholangiopancreatography (ERCP): International survey study. Endosc Int Open 2023; 11: E588-E598
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Ak Ç, Aykut H, Pala E. et al. Post-ERCP complication analysis of an experienced center. Surg Laparosc Endosc Percutan Tech 2022; 32: 707-713
    CrossrefPubMedSearch in Google Scholar
  • 6 Williams EJ, Taylor S, Fairclough P. et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. Endoscopy 2007; 39: 793-801
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Andriulli A, Loperfido S, Napolitano G. et al. Incidence rates of post-ERCP complications: a systematic survey of prospective studies. Am J Gastroenterol 2007; 102: 1781-1788
    CrossrefPubMedSearch in Google Scholar
  • 8 Güitrón-Cantú A, Adalid-Martínez R, Gutiérrez-Bermúdez JA. et al. Complications in diagnostic and therapeutic endoscopic cholangiopancreatography. Prospective study. Rev Gastroenterol Mex 2007; 72: 227-235
    PubMedSearch in Google Scholar
  • 9 Marsano LS. Principles of Electrosurgery. https://louisville.edu/medicine/departments/medicine/dividions/gimedicine/physician-resources/lectures/procedures/electrocautery
    PubMed
  • 10 Fukami N. Endoscopic submucosal dissection – principles and practice. New York: Springer; 2015
    CrossrefSearch in Google Scholar
  • 11 Ratani RS, Mills TN, Ainley CC. et al. Electrophysical factors influencing endoscopic sphincterotomy. Gastrointest Endosc 1999; 49: 43-52
    CrossrefPubMedSearch in Google Scholar
  • 12 Rey JF, Beilenhoff U, Neumann CS. et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy 2010; 42: 764-772
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Perini RF, Sadurski R, Cotton PB. et al. Post-sphincterotomy bleeding after the introduction of microprocessor-controlled electrosurgery: does the new technology make the difference. Gastrointest Endosc 2005; 61: 53-57
    CrossrefPubMedSearch in Google Scholar
  • 14 Curtiss LE. High frequency currents in endoscopy: a review of principles and precautions. Gastrointest Endosc 1973; 20: 9-12
    CrossrefPubMedSearch in Google Scholar
  • 15 Funari MP, Ribeiro IB, de Moura DTH. et al. Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials. Clin Res Hepatol Gastroenterol 2020; 44: 739-752
    CrossrefPubMedSearch in Google Scholar
  • 16 Verma D, Kapadia A, Adler DG. Pure versus mixed electrosurgical current for endoscopic biliary sphincterotomy: a meta-analysis of adverse outcomes. Gastrointest Endosc 2007; 66: 283-290
    CrossrefPubMedSearch in Google Scholar
  • 17 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71
    CrossrefPubMedSearch in Google Scholar
  • 18 PROSPERO 2019. https://www.crd.york.ac.uk/PROSPERO/
    CrossrefPubMed
  • 19 Cochrane Handbook for Systematic Reviews of Interventions [Internet]. Cochrane.org.2019. https://www.training.cochrane.org/handbook
    PubMed
  • 20 Review Manager (RevMan). Version 5. 4. 1. The Cochrane Collaboration, 21 09. 2020. https://revman.cochrane.org.
    PubMed
  • 21 Gradepro.org. https://www.gradepro.org/terms/cite
    PubMed
  • 22 Higgins JP, Altman DG, Gøtzsche PC. et al. Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    CrossrefPubMedSearch in Google Scholar
  • 23 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
    CrossrefPubMedSearch in Google Scholar
  • 24 Cirocchi R, Kelly MD, Griffiths EA. et al. A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system. Surgeon 2017; 15: 379-387
    CrossrefPubMedSearch in Google Scholar
  • 25 Li DF, Yang MF, Chang X. et al. Endocut versus conventional blended electrosurgical current for endoscopic biliary sphincterotomy: A meta-analysis of complications. Dig Dis Sci 2019; 64: 2088-2094
    CrossrefPubMedSearch in Google Scholar
  • 26 Pereira Funari M, Ottoboni Brunaldi V, Mendonça Proença I. et al. Pure cut or Endocut for biliary sphincterotomy? A multicenter randomized clinical trial. Am J Gastroenterol 2023; 118: 1871-1879
    CrossrefPubMedSearch in Google Scholar
  • 27 Norton ID, Petersen BT, Bosco J. et al. A randomized trial of endoscopic biliary sphincterotomy using pure-cut versus combined cut and coagulation waveforms. Clin Gastroenterol Hepatol 2005; 3: 1029-1033
    CrossrefPubMedSearch in Google Scholar
  • 28 Tsang HC, Lam CS, Chu PW. et al. A randomized controlled trial of auricular transcutaneous electrical nerve stimulation for managing posthysterectomy pain. Evid Based Complement Alternat Med 2011; 2011: 276769
    CrossrefPubMedSearch in Google Scholar
  • 29 Freeman ML, Nelson DB, Sherman S. et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335: 909-918
    CrossrefPubMedSearch in Google Scholar
  • 30 Köksal AŞ, Eminler AT, Parlak E. Biliary endoscopic sphincterotomy: Techniques and complications. World J Clin Cases 2018; 6: 1073-1086
    CrossrefPubMedSearch in Google Scholar
  • 31 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-683
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Kim HJ, Kim MH, Kim DI. et al. Endoscopic hemostasis in sphincterotomy-induced hemorrhage: its efficacy and safety. Endoscopy 1999; 31: 431-436
    Thieme ConnectPubMedSearch in Google Scholar
  • 33 Serrano JPR, de Moura DTH, Bernardo WM. et al. Nonsteroidal anti-inflammatory drugs versus placebo for post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E477-E486
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Akshintala VS, Sperna Weiland CJ, Bhullar FA. et al. Non-steroidal anti-inflammatory drugs, intravenous fluids, pancreatic stents, or their combinations for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and network meta-analysis. Lancet Gastroenterol Hepatol 2021; 6: 733-742
    CrossrefPubMedSearch in Google Scholar
  • 35 Thanage R, Jain S, Chandnani S. et al. Is the combination of rectal diclofenac and intravenous ringer lactate superior to individual therapy for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis: A prospective, open-label, single-center randomized trial. Pancreas 2021; 50: 1236-1342
    CrossrefPubMedSearch in Google Scholar
  • 36 Marín-Gabriel JC, Romito R, Guarner-Argente C. et al. Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors. Gastroenterol Hepatol 2019; 42: 512-523
    CrossrefPubMedSearch in Google Scholar
  • 37 Puig I, Calvet X, Baylina M. et al. How and when should NSAIDs be used for preventing post-ERCP pancreatitis? A systematic review and meta-analysis. PLoS One 2014; 9: e92922
    CrossrefPubMedSearch in Google Scholar
  • 38 Chandrasekhara V, Khashab MA, Muthusamy VR. et al. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
    CrossrefPubMedSearch in Google Scholar
  • 39 Jena A, Jain S, Sundaram S. et al. Electrosurgical unit in GI endoscopy: the proper settings for practice. Expert Rev Gastroenterol Hepatol 2023; 17: 825-835
    CrossrefPubMedSearch in Google Scholar
  • 40 Sterne JAC, Savović J, Page MJ. et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898
    CrossrefPubMedSearch in Google Scholar