First cut, then blend: An electrocautery technique affecting bleeding at sphincterotomy

Background and Study Aims: The use of pure cut electrocautery current for e ndoscopic sphincterotomy lowers pancreatitis rates, following endoscopic re trograde cholangiopancreatography (FRCP), but at the expense of greater loc alized bleeding which partially obscures the endoscopic view. We hypothesiz ed that localized bleeding could be decreased by using blended current at t he end of the sphincterotomy, without losing the benefit associated with pu re cut current of lower post-ERCP pancreatitis benefit. Patients arid Methods: Patients undergoing sphincterotomy were randomly all ocated to receive pure cut current alone or a sequential combination of pur e cut then blended current. In the sequential combination patients, the fir st 75-80% of the sphincterotomy was done using pure cut current at 30 W and the remainder completed at a blend 2 setting (pure cut plus coagulation cu rrent), also at 30 W. Results: 142 patients were enrolled in the study. No statistical difference was noted between the two groups in the rates of overall pancreatitis or b leeding requiring transfusion. When comparing visible bleeding rates (more than a few drops), we found that there was significantly more bleeding (P < 0.05) in the pure cut group (31/75, 41%) at the time of sphincterotomy comp ared with the sequential combination group (16/67, 23%). Conclusions: A sequential combination of pure cut and blended current for s phincterotomy caused less visible bleeding than pure cut alone. This occurr ed without a change in the rate of post-FRCP pancreatitis.