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Systematic review and network meta-analysis: comparison of different techniques for difficult biliary cannulation.
Yen-Ying Wu1, Sz-Iuan Shiu2,3, Chun-Fang Tung1,4
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
BMC Gastroenterology
|April 30, 2026
Summary
For difficult biliary cannulation during ERCP, transpancreatic biliary sphincterotomy (TPS) improves success rates. Precut fistulotomy (PF) significantly reduces complications, especially post-ERCP pancreatitis.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Surgical Techniques
Background:
- Difficult biliary cannulation (DBC) complicates ERCP, increasing procedure time and adverse events.
- Various techniques exist to aid DBC, but optimal methods remain unclear.
Purpose of the Study:
- To conduct a network meta-analysis comparing seven interventions for DBC.
- To evaluate deep cannulation rates and post-ERCP complications.
Main Methods:
- Systematic review of comparative trials up to January 2024.
- Inclusion of 17 randomized controlled trials with 2,189 participants.
- Comparison of precut papillotomy (PP), precut fistulotomy (PF), transpancreatic biliary sphincterotomy (TPS), and others against a control group.
Main Results:
- Transpancreatic biliary sphincterotomy (TPS) showed superior cannulation efficacy (OR 6.00).
- Precut fistulotomy (PF) was associated with a significantly lower overall complication rate (OR 0.61).
- PF specifically reduced post-ERCP pancreatitis without affecting bleeding, perforation, or infection rates.
Conclusions:
- TPS is effective for improving cannulation success in DBC.
- PF demonstrates a significant reduction in complications, particularly post-ERCP pancreatitis.
