Precut sphincterotomy: efficacy for ductal access and the risk of adverse events.

ABSTRACT

BACKGROUND: Successful ductal access is achieved in 90% of patients who undergo ERCP. Precut sphincterotomy has been advocated when routine cannulation is not possible. OBJECTIVE: To evaluate the efficacy of precut sphincterotomy for ductal access and the risk of adverse events including post-ERCP pancreatitis (PEP) associated with it. DESIGN: Retrospective analysis of ERCP procedures performed from 2002 to 2011. SETTING: Referral center. PATIENTS A total of 10,202 consecutive patients who underwent native cannulation ERCP. MAIN OUTCOME MEASUREMENTS Efficacy for ductal access and risk of adverse events including PEP. RESULTS: A total of 706 patients required precut sphincterotomy, 614 of whom (86.9%) had successful biliary cannulation. PEP was diagnosed in 58 (8.2 %), perforation in 6 (0.8%), and bleeding in 49 (6.9%) patients. On multivariate analysis, unsuccessful precut sphincterotomy (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.53-4.40; P < .001) and female sex (OR 1.95; 95% CI, 1.23-3.07; P = .004) were associated with increased risk of the development of adverse events. Female sex (OR 2.42; 95% CI, 1.29-4.55; P = .006) and sphincter of Oddi dysfunction (OR 2.77; 95% CI, 1.16-6.60; P = .02) were associated with an increased risk of PEP. LIMITATIONS: Retrospective study. CONCLUSIONS: Precut sphincterotomy is effective in achieving ductal access when standard cannulation techniques fail. A successful precut sphincterotomy is not associated with an increased risk of adverse events.