Luís Lopes1, Mário Dinis-Ribeiro2, Carla Rolanda3. 1. Department of Gastroenterology, Hospital of Santa Luzia, Viana do Castelo, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal. 2. Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal. 3. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal; Department of Gastroenterology, Hospital of Braga, Braga, Portugal.
Abstract
BACKGROUND: The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed. OBJECTIVE: To assess the success, safety, and procedure duration of an early precut fistulotomy (group A) versus a classic precut strategy after a difficult biliary cannulation (group B). DESIGN: Single-center, prospective cohort study. SETTING: University-affiliated hospital. PATIENTS: A total of 350 patients with a naïve papilla. INTERVENTIONS: Standard biliary cannulation followed by needle-knife fistulotomy (NKF). MAIN OUTCOME MEASUREMENTS: Biliary cannulation rate, NKF success, adverse events, and ERCP duration. RESULTS: The overall cannulation rate was similar, at 96% and 94% for groups A and B, respectively. The adverse event rate was 6.2% and 6.4%, respectively, with pancreatitis as the most frequent adverse event (group A, 3.9%; group B, 5.2%). The mean ERCP duration was, however, significantly shorter in group A, both when biliary cannulation was achieved without precutting (14 minutes vs 25 minutes, P < .001) as well as when biliary cannulation was attempted after NKF (18 minutes vs 31 minutes, P < .0001). LIMITATIONS: Single-center study design, referral center. CONCLUSIONS: If the endoscopist is experienced in ERCP and precut techniques, an early precut strategy should be the preferred cannulation strategy because this approach is as safe and effective as the late fistulotomy approach and substantially reduces ERCP duration.
BACKGROUND: The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed. OBJECTIVE: To assess the success, safety, and procedure duration of an early precut fistulotomy (group A) versus a classic precut strategy after a difficult biliary cannulation (group B). DESIGN: Single-center, prospective cohort study. SETTING: University-affiliated hospital. PATIENTS: A total of 350 patients with a naïve papilla. INTERVENTIONS: Standard biliary cannulation followed by needle-knife fistulotomy (NKF). MAIN OUTCOME MEASUREMENTS: Biliary cannulation rate, NKF success, adverse events, and ERCP duration. RESULTS: The overall cannulation rate was similar, at 96% and 94% for groups A and B, respectively. The adverse event rate was 6.2% and 6.4%, respectively, with pancreatitis as the most frequent adverse event (group A, 3.9%; group B, 5.2%). The mean ERCP duration was, however, significantly shorter in group A, both when biliary cannulation was achieved without precutting (14 minutes vs 25 minutes, P < .001) as well as when biliary cannulation was attempted after NKF (18 minutes vs 31 minutes, P < .0001). LIMITATIONS: Single-center study design, referral center. CONCLUSIONS: If the endoscopist is experienced in ERCP and precut techniques, an early precut strategy should be the preferred cannulation strategy because this approach is as safe and effective as the late fistulotomy approach and substantially reduces ERCP duration.
Authors: Su Jin Kim; Dae Hwan Kang; Hyung Wook Kim; Cheol Woong Choi; Su Bum Park; Byeong Jun Song; Young Mi Hong Journal: World J Gastroenterol Date: 2015-05-21 Impact factor: 5.742
Authors: Tae Hoon Lee; Sang-Heum Park; Jae Kook Yang; Su Jung Han; Suyeon Park; Hyun Jong Choi; Yun Nah Lee; Sang-Woo Cha; Jong Ho Moon; Young Deok Cho Journal: Gut Liver Date: 2018-09-15 Impact factor: 4.519