Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis

Choudhary, Abhishek; Winn, Jessica; Siddique, Sameer; Arif, Murtaza; Arif, Zainab; Hammoud, Ghassan M.; Puli, Srinivas R.; Ibdah, Jamal A.; Bechtold, Matthew L.

doi:10.3748/wjg.v20.i14.4093

Cited by 54 publications

(46 citation statements)

References 25 publications

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“…38 Subgroup analysis of a meta-analysis revealed that NKF significantly decreased the risk of PEP (OR, .27; 95% CI, .09-.82) with an absolute risk reduction of 5% (95% CI, 1%-10%), whereas NKP did not (OR, .89; 95% CI, .41-1.92). 34 In a retrospective study NKF had a lower PEP rate than the others; the PEP rates of NKF, NKP, and TPS were 2.6%, 21%, and 22.4%, respectively (P Z .001). 40 Therefore, if the pancreatic duct can be cannulated, a pancreatic stent should be placed before NKP to guide the precut and to reduce PEP risk; a retrospective study showed that precutting over a pancreatic stent achieved a higher success rate and a lower adverse event rate.…”

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confidence: 92%

“…33 Another meta-analysis showed that the ORs of PEP for using the precut technique immediately and within 5 or 10 minutes of standard cannulation were .73 (95% CI, .23-2.33), .85 (95% CI, .40-1.80), and .55 (95% CI, .29-1.03), respectively. 34 In terms of PEP, 10 minutes appears to be the optimum time allowed for the standard cannulation technique before considering the use of precut technique. Notably, precut technique requires expertise and is associated with a higher risk of adverse events, particularly perforation and bleeding, when performed by low-volume endoscopists.…”

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confidence: 99%

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International consensus recommendations for difficult biliary access

Liao

Angsuwatcharakon

Isayama

et al. 2017

Gastrointestinal Endoscopy

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mentioning

confidence: 92%

mentioning

confidence: 99%

International consensus recommendations for difficult biliary access

Liao

Angsuwatcharakon

Isayama

et al. 2017

Gastrointestinal Endoscopy

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“…TPS technique is a relatively new precut technique among the various precut techniques, which was first described in 1995. Previous studies have found that TPS is a safe and effective procedure in patients with difficult bile duct access . However, the use of the precut technique for achieving deep cannulation of the bile duct is not recommended for inexperienced endoscopists as it is claimed to increase post‐ERCP complications …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have found that TPS is a safe and effective procedure in patients with difficult bile duct access. 24 However, the use of the precut technique for achieving deep cannulation of the bile duct is not recommended for inexperienced endoscopists as it is claimed to increase post-ERCP complications. 25 Compared to standard cannulation, DWT may replace standard cannulation or become the salvage procedure in cases of unsuccessful biliary cannulation as a result of its high success rate with an acceptable incidence of PEP.…”

Section: Discussionmentioning

confidence: 99%

Comparison between double‐guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation

Huang

Zhang

et al. 2014

Digestive Endoscopy

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“…In fact, "moving" the precut technique earlier during a difficult cannulation has been associated with a decreased risk of PEP [13]. Moreover, PF compared to conventional precut technique significantly decreased the PEP rate in a systematic metaanalysis [14]. The most reasonable explanation is that during conventional precut, the pancreatic orifice is not protected and injuries may occur.…”

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confidence: 99%

Precut fistulotomy for choledocholithiasis: what about long-term efficacy?

Gkolfakis

Arvanitakis

2020

Endosc Int Open

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Patients with choledocholithiasis present with a variety of symptoms ranging from biliary colic to severe acute pancreatitis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard to treat them [1]. Simple ERCP cannulas or bendable papillotomes have been developed to facilitate access to the common bile duct (CBD), followed by incision of the sphincter allowing stone extraction using balloon extractor catheters or basket wires.In approximately 20 % of patients undergoing ERCP, CBD cannulation may fail due to difficult cannulation [2], defined as more than five cannulation attempts, or attempts lasting more than 5 minutes, or two or more unintentional pancreatic guidewire passages. If the pancreatic duct is repeatedly cannulated or injected, the pancreatic guidewire (PGW)-assisted technique is recommended [3]. However, the pancreatic duct is not always easily accessible, and in those cases, experienced endoscopists resort to one of the precutting techniques (precut fistulotomy and conventional precut technique) based on a patient's characteristics (e. g. papilla's size and morphology) and endoscopist expertise [4,5].Precut fistulotomy (PF) aims to avoid injuring the distal part of the sphincter (including the pancreatic duct) by using a needle-knife to perform a stepwise incision of the mucosa. The incision starts approximately 3 mm over the roof of the papilla, followed by an upward or downward cut until the biliary sphincter or the bile duct is visualized. On the other hand, the conventional precut technique consists of a stepwise incision of the mucosa starting at the upper end of the orifice in the expected direction of the bile duct until visualization of the whitish onion skin-appearing sphincter muscle. Both techniques increase the rate of success with selective biliary cannulation, but they have also been identified as risk factors for post-ERCP pancreatitis (PEP) [6].Choledocholithiasis recurrence after ERCP is not rare [7]. Risk factors include, among others, the CBD diameter; presence of biliary stricture, gallstones or peri-ampullary diverticulum; and sphincterotomy itself [8]. Whether precut fistulotomy, by retaining integrity of the distal papillary sphincter, could also act as a potential risk factor for CBD stones recurrence remains unknown. This question is being elucidated in the current issue of Endoscopy International Open by Archibugi et al. [9].In their retrospective study the authors included 85 patients with a diagnosis of choledocholithiasis treated by CBD clearance after PF. These cases were age and sex matched with respective patients fulfilling inclusion criteria but undergoing conventional endoscopic biliary sphincterotomy (BS). Primary and secondary endpoints consisted of stone recurrence rate (defined as the need to repeat ERCP or new admission for biliary event) and complication rate, respectively. Two experienced endoscopists performed all examinations.No difference was shown in long-term disease recurrence (14.1 % vs. 12.9 % for PF a...

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Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis

Abstract: Early precut technique for common bile duct cannulation decreases the trend of post-ERCP pancreatitis.

Cited by 54 publications

References 25 publications

International consensus recommendations for difficult biliary access

International consensus recommendations for difficult biliary access

Comparison between double‐guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation

Precut fistulotomy for choledocholithiasis: what about long-term efficacy?

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