Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease

Digestive and Liver Diseases, 07/07/2011

Testoni PA et al. – Pancreatitis rate was lower when precut was done with <10 attempts than when ≥10 attempts were made without precutting. In experienced hands precut biliary sphincterotomy does not seem to be an independent risk factor for post–ERCP pancreatitis in patients undergoing endoscopic retrograde cholangio–pancreatography for bile duct stones.

Methods

  • 2004 patients undergone endoscopic retrograde cholangio-pancreatography over a 9-year period for bile stones were evaluated.
  • Pancreatitis rate was assessed in relation to the number of cannulation attempts (<10 and ≥10) and precutting.

Results

  • Procedures were successful in 1878 patients (93.7%).
  • Cannulation was done without precutting in 1717 cases and with in 161.
  • Pancreatitis occurred in 2.7% of patients who had undergone biliary cannulation without precutting and in 6.5% with (p=0.006).
  • It was lower with <10 attempts than with ≥10 (p<0.0001), either without (p<0.0001) or with precutting (p<0.01).
  • Pancreatitis rate did not differ without and with precutting when <10 attempts at cannulation were done, whilst it was lower when precut was done before 10 attempts than when 10 or more attempts were made without precutting (p=0.02).

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