Precut papillotomy: a method to improve success of ERCP and papillotomy.

The use of precut papillotomy as an aid to diagnosis with ERCP and an expedient method for endoscopic papillotomy is described. Precut papillotomy enables the experienced endoscopist to increase the successful opacification of the biliary tree in cases in which other techniques have failed, including ERCP, and to initiate a papillotomy or sphincterotomy when the papillotome cannot be introduced completely into the papilla without serious complications. Precut papillotomy is recommended when opacification of the biliary tree or introduction of the papillotome is precluded because of papillary stenosis, impacted calculi or anatomic variations, either natural or acquired, but should only be performed by the endoscopist with experience in both ERCP and papillotomy.