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Precut sphincterotomy: efficacy for ductal access and the risk of adverse events
Udayakumar Navaneethan1, Rajesh Konjeti2, Vennisvasanth Lourdusamy1
1Digestive Disease Institute, The Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Successful ductal access is achieved in 90% of patients who undergo ERCP. Precut sphincterotomy has been advocated when routine cannulation is not possible.
Objective:
To evaluate the efficacy of precut sphincterotomy for ductal access and the risk of adverse events including post-ERCP pancreatitis (PEP) associated with it.
Design:
Retrospective analysis of ERCP procedures performed from 2002 to 2011.
Setting:
Referral center.
Patients:
A total of 10,202 consecutive patients who underwent native cannulation ERCP.
Main Outcome Measurements:
Efficacy for ductal access and risk of adverse events including PEP.
Results:
A total of 706 patients required precut sphincterotomy, 614 of whom (86.9%) had successful biliary cannulation. PEP was diagnosed in 58 (8.2 %), perforation in 6 (0.8%), and bleeding in 49 (6.9%) patients. On multivariate analysis, unsuccessful precut sphincterotomy (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.53-4.40; P < .001) and female sex (OR 1.95; 95% CI, 1.23-3.07; P = .004) were associated with increased risk of the development of adverse events. Female sex (OR 2.42; 95% CI, 1.29-4.55; P = .006) and sphincter of Oddi dysfunction (OR 2.77; 95% CI, 1.16-6.60; P = .02) were associated with an increased risk of PEP.
Limitations:
Retrospective study.
Conclusions:
Precut sphincterotomy is effective in achieving ductal access when standard cannulation techniques fail. A successful precut sphincterotomy is not associated with an increased risk of adverse events.
