Pure Cut or Endocut for Biliary Sphincterotomy? A Multicenter Randomized Clinical Trial

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Technology

Background:

• Adverse events (AE) are common after endoscopic retrograde cholangiopancreatography (ERCP).
• Post-ERCP acute pancreatitis (PEP) is a significant complication.
• Thermal injury during biliary sphincterotomy may contribute to PEP and bleeding.

Purpose of the Study:

• To compare the outcomes of two electric current modes during biliary sphincterotomy.
• To evaluate the incidence of PEP and other adverse events associated with each mode.

Main Methods:

• A randomized controlled trial involving 550 patients undergoing ERCP with biliary sphincterotomy.
• Patients were randomized to either pure cut or endocut electric current modes.
• Primary outcome was PEP incidence; secondary outcomes included bleeding, infection, and perforation.

Main Results:

• The overall PEP rate was 4.0%, significantly higher in the endocut group (5.8%) compared to the pure cut group (2.2%).
• Endocut mode and more than 5 attempts were identified as risk factors for PEP.
• Pure cut mode was associated with more intraprocedural bleeding, while endocut mode had more delayed bleeding. No significant differences in perforation or infection rates were observed.

Conclusions:

• Endocut mode may increase thermal injury, leading to higher PEP and delayed bleeding rates.
• Pure cut mode is associated with increased intraprocedural bleeding, but it is generally manageable.
• Further research is needed to assess electric current impact on AE with preventive measures.