PAPILLARY ROOF INCISION USING THE ERLANGEN-TYPE PRE-CUT PAPILLOTOME TO ACHIEVE SELECTIVE BILE-DUCT CANNULATION

Background: Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation fails have usually used the needle-knife papillotome. We conducted a prospective study to eva luate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. Patients and Methods: Three hundred twenty-seven pati ents (114 men, mean age 67 years) who underwent first-time sphincterot omy at our institution were included. Pre-cutting was performed if fre e and wire-guided cannulation of the bile duct failed according to an algorithm. Results: Pre-cutting was performed in 123 patients (38%) an d selective cannulation was successful in all. Post-ERCP serum pancrea tic enzyme levels were more frequently elevated in the pre-cut group ( 50%) than the non-pre-cut group (27%, p < 0.001); however, there was n o difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7 %, 95% CI: 0.66% to 7.6%; non-precut = 1.6%, 95% CI: 0.3% to 4.7%). Th e incidence of bleeding was similar (precut, 2.4%, non-pre-cut, 3.9%; p > 0.05). Conclusion: Pre-cutting the major papilla for biliary acces s using the Erlangen-type pre-cut papillotome is an effective and reas onably safe procedure when performed by endoscopists with extensive ex perience in pancreatobiliary endoscopy.