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[Precut sphincterotomy: efficacy and complications]
A Güitrón1, R Adalid, R Barinagarrementería
1Departamento de Endoscopía Digestiva, Hospital de Especialidades No. 71, Centro Médico Nacional Torreón, Instituto Mexicano del Seguro Social (IMSS), Coahuila.
Background:
The use of precut sphincterotomy has been criticized as potentially unsafe. Despite this, a number of tertiary referral center have reported their successful use of this technique to increase the rate of common bile duct cannulation and therapeutic procedures.
Aim:
To evaluate precut papillotomy and correlate the complication rate. METHODS-PATIENTS AND RESULTS: We performed precut sphincterotomy in 120 patients in whom attempts at standard common bile duct cannulation and sphincterotomy were unsuccessful. Bile duct diameters were correlated to the complication rate. Cannulation of the common bile duct and endoscopic sphincterotomy was successful immediately after precut sphincterotomy in 103 patients (86%), and was successful in 12 of the 17 patients who underwent repeat ERCP, for a total cannulation and sphincterotomy rate of 96%. Eight patients (6.9%) experienced complications: six bleeding, and two retroduodenal perforation. There was no procedure-related mortality, and complications were managed medically except on patient with bleeding who required surgical intervention.
Conclusions:
Precut sphincterotomy was effective and safe in facilitating cannulation and sphincterotomy in patients in whom standard cannulation attempts failed. Excluding patients with small duct size may further reduce the complication rate.