Early precut sphincterotomy for difficult biliary access to reduce post-ERCP pancreatitis: a randomized trial

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Pancreatology

Background:

• Precut sphincterotomy is used for difficult biliary cannulation during ERCP.
• It's a known risk factor for post-ERCP pancreatitis (PEP).
• The cause of PEP risk (technique vs. repeated cannulation) is unclear.

Purpose of the Study:

• To assess PEP incidence comparing early precut vs. standard technique in difficult biliary cannulation.
• To compare complications and cannulation success rates.

Main Methods:

• Prospective, multicenter, randomized clinical trial.
• Patients randomized to early precut (Group A) or repeated cannulation with late precut if failed (Group B).
• PEP defined by pain and elevated pancreatic enzymes >24h post-procedure.

Main Results:

• PEP incidence was 5.4% in the early precut group vs. 12.1% in the delayed precut group (OR 0.35).
• PEP was significantly lower in the early precut group (5.4%) compared to the delayed precut subgroup (14.1%).
• No significant differences observed in cannulation success, bleeding, perforation, or cholangitis rates.

Conclusions:

• Early precut sphincterotomy is effective in reducing PEP incidence during difficult biliary cannulation.
• Repeated biliary cannulation attempts are a significant risk factor for post-ERCP pancreatitis.