[Safety and efficacy of sphincterotomy using guided and precut techniques. A 5-year experience]

Endoscopic sphincterotomy (ES) by itself is safe and effective, with acceptable rates of morbidity and mortality. However, for various reasons ES cannot be successfully completed in all cases, and other treatment options must be considered, including precut or guided sphincterotomy. Results from studies evaluating precut sphincterotomy are conflicting.

The aim of this prospective trial was to assess the safety and efficacy of standard, guided and precut endoscopic sphincterotomy.

During a period of 5 years, endoscopic retrograde cholangiopancreatography (ERCP) was performed 1,000 times. Of five hundred seven patients, 364 were women and 143 men, had biliary obstruction and were candidates for ES, which was successful in 477 (94%). Sixteen (3.3%) complications occurred, but only 6 (1.25%) were serious. Procedure-related mortality occurred in one patient (0.2%).

In 346 patients (68.2%) we performed standard ES, in 86 (16.9%) precut, in 45 (8.9%) guided and in 30 (6.0%) ES cannot be successfully completed. Morbidity rate for endoscopic management of three-sphincterotomy types is similar, with 3.7% in standard ES, 2.3% in precut and 2.2 in guided sphincterotomy.

Standard ES, precut and guided sphincterotomy are safety and efficacy and complication rate can be lowered if the procedure is strictly focused to local anatomy and therapeutic requirements.