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Safety and efficacy of primary precut techniques for biliary cannulation: a systematic review and meta-analysis.
Eugene Annor1, Nneoma Ubah2, Dhaval Save3
1Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Clinical Endoscopy
|October 10, 2025
Summary
Needle-knife precut sphincterotomy (NKPS) is a safe and effective primary technique for biliary cannulation during ERCP. This method shows high success rates and acceptable adverse event profiles, supporting its use as a first-line approach.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Surgical Techniques
Background:
- Biliary cannulation is crucial for ERCP success.
- Standard cannulation methods can be challenging.
- Needle-knife precut sphincterotomy (NKPS) is an alternative when standard techniques fail.
Purpose of the Study:
- To evaluate the safety and efficacy of NKPS as a primary biliary cannulation technique in ERCP.
- To determine the success rate and adverse event profile of primary NKPS.
Main Methods:
- Systematic review and meta-analysis of studies from January 2000 to November 2024.
- Included studies assessing primary precut techniques, defined as NKPS as the initial approach.
- Pooled proportions calculated using random-effects models; heterogeneity assessed via Q-test and I² statistic.
Main Results:
- High cannulation success rate of 96.50% with no significant heterogeneity.
- Low rates of adverse events: pancreatitis (1.90%), bleeding (2.60%), cholangitis (1.50%), and perforation (0.90%).
- Overall adverse event rate was 9.70%, with significant heterogeneity observed (I²=83.39%).
Conclusions:
- Primary NKPS is an effective and safe technique for biliary cannulation in ERCP.
- Supports the consideration of primary NKPS as a viable first-line approach in suitable clinical scenarios.
- Further research may explore optimizing patient selection and procedural techniques.
