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Endoscopy 2003; 35(8): S24-S30
DOI: 10.1055/s-2003-41528
Biliopancreas
© Georg Thieme Verlag Stuttgart · New York

The Precut – When, Where and How? A Review

P.  V.  J.  Sriram1 , G.  V.  Rao1 , D.  Nageshwar Reddy1
  • 1 1Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Publication History

Publication Date:
20 August 2003 (online)

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Introduction

Gaining access to the biliary or pancreatic duct is the most important step for a successful therapeutic biliary pancreatic endoscopy. The overall success rate of cannulation ranges from 90 to 95 % even when performed by experts [1]. In about 5 to 10 % of cases, the common bile duct remains inaccessible necessitating ”precut” [2] [3] [4] [5]. Precut sphincterotomy is the Achilles’ heel of many an endoscopist and the ultimate tool in the biliary endoscopist’s armamentarium for gaining access across the papilla to facilitate biliary endotherapy. It is often considered to be ‘dangerous’, ‘complicated’ and to be reserved for the ‘experts’ [6]. Like any other interventional procedure, precut is associated with its attendant risks and morbidity, the most important complication being endoscopic retrograde cholangiopancreatography (ERCP) induced acute pancreatitis [7] [8] [9] [10] [11] [12] [13] [14]. This follows trauma and edema of the papilla due to multiple unsuccessful attempts and inadvertent pancreatic duct cannulations and precutting in such circumstances results in higher morbidity, especially when performed on undilated bile ducts [15] [16]. Hence, it is all the more important to teach and train the inexperienced about when, where, and how to do precut sphincterotomy. We have reviewed precutting with regard to its basis, technical aspects, and the available relevant literature.

References

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D. Nageshwar Reddy M. D., D. M.

Director & Chief, Department of Gastroenterology

6-3-652, Dhruvatara Apartment · Somajiguda · Hyderabad-500082 · India

Fax: + 91-40-23324255

Email: nage@satyam.net.in