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Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial.
S-J Tang1, G B Haber, P Kortan
1The Center for Advanced Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Endoscopy
|January 20, 2005
Summary
For difficult biliary cannulation during ERCP, precut papillotomy and persistence techniques show similar success and complication rates in experienced hands. Both methods are effective for achieving deep cannulation when initial attempts fail.
Area of Science:
- Gastroenterology
- Endoscopic Retrograde Cholangiopancreatography (ERCP)
Background:
- Failed biliary cannulation during ERCP occurs in up to 10% of patients.
- The efficacy and safety of precut techniques for difficult cannulation remain debated.
- No prior randomized trials have directly compared precut techniques with persistence strategies.
Purpose of the Study:
- To compare the success rates of precut papillotomy versus persistence for difficult biliary cannulation.
- To compare the complication rates associated with precut papillotomy versus persistence.
- To evaluate outcomes in patients undergoing ERCP with challenging biliary access.
Main Methods:
- Patients with failed cannulation after 12 minutes were randomized to precut or persistence.
- Precut involved needle-knife access; persistence used a non-wire-guided papillotome.
- Primary success was defined as deep cannulation within 15 minutes; complications were tracked for 30 days.
Main Results:
- In patients with difficult cannulation, primary success rates were similar: 75% for precut vs. 73% for persistence.
- Complication rates were also comparable: 4% for precut vs. 9% for persistence.
- The overall final cannulation success rate across all patients was 99.5%.
Conclusions:
- Precut papillotomy and persistence are equally effective for difficult biliary cannulation in experienced endoscopists' hands.
- Both techniques demonstrate similar complication profiles.
- These findings support the use of either strategy based on endoscopist preference and expertise.
