Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study

Abstract

In experienced hands, an approach using primary precut appears to be at least as successful and safe as a conventional approach using guide-wire-based CBD cannulation followed by ES, and might also be a quicker method.

Early precut fistulotomy for biliary access: time to change the paradigm of “the later, the better”?

“…4,6,19 The adverse event rate for the precut strategy reported in the medical literature varies from 2% to 30%, depending on several factors, including the expertise of the center, the selection of patients, and the design of the study. 4,20,21 As the use of the precut strategy generally follows a difficult cannulation, it remains a matter of debate whether the increased risk is related to the precut itself or is linked to the manipulation of the papilla that precedes it. A difficult cannulation is characterized by repeated biliary attempts and/or manipulation (wires and injection of contrast) of the main pancreatic duct, which is in likely to induce trauma, edema, and inflammation to the papillary bed, thus obstructing main pancreatic duct drainage.…”

Suprapapillary needleknife fistulotomy: a safe and effective method for accessing the biliary system

“…However, the reported studies were small and encompassed a number of different precutting approaches [6,7].…”

Fistulotomia papilar versus cateterização convencional para acesso biliar endoscópico: avaliação clínico-laboratorial

“…No cálculo da amostra considerando a taxa de sucesso no acesso ao ducto biliar pela canulação do óstio papilar de 75% e pela fistulopapilotomia de 95% 4,5 , serão necessários 55 pacientes em cada grupo para detectar diferença estatística nas duas técnicas, com significância de 0,05 pelo teste bilateral e 80% de detectar a diferença. No estudo, foram alocados 51 pacientes em cada grupo.…”

“…A distância do óstio papilar para a artéria nutridora é Em relação a perfuração são relatados na literatura incidência de 0% a 1,8% 5,12,65,[76][77][78] . Neste estudo, ocorreram duas perfurações (3,9%) no…”

“…A incidência de hemorragia foi semelhante a estudos prévios de pré-corte e variam de 0 a 3,4% 5,12,65,[76][77][78] .…”