Abstract
Background and Study Aims: Precut sphincterotomy remains a controversial means of gaining biliary access during endoscopic retrograde cholangiopancreatography (ERCP). This report is a retrospective evaluation of the use of needle-knife sphincterotomy as a precut procedure to achieve biliary access during ERCP.
Patients and Methods: From November 1992 to August 1993, a total of 1071 ERCPs were performed at our institution. During this time, precut sphincterotomy was carried out in 180 patients, with complete follow-up obtained in 178 patients. The follow-up concentrated on the efficacy of the procedure and short-term complications.
Results: Cannulation of the common bile duct was achieved immediately after precut sphincterotomy in 88 % of the patients, and during a second ERCP in an additional 11 % of patients (total success rate 99 %). There were no precut-related deaths. The complication rate of precut sphincterotomy was 21 in 178 (12 %). Complications included bleeding in ten patients (5.5 %), perforation in four patients (3 %), pancreatitis in one patient (0.5 %), and fever of unknown origin in six (3 %) patients. All complications were managed conservatively.
Conclusions: Precut sphincterotomy is a safe and highly effective method of gaining biliary access in patients in whom deep cannulation proves difficult or impossible and biliary access is considered essential.
