The Efficacy and Safety of Precut Technique in Difficult Biliary Cannulation

Objective:To evaluate the efficacy and safety of the precutting techniques for difficult CBD cannulation.Methods:Retrospective study the precutting cases due to difficult cannulation from September 1997 to December 2007.All the cases couldn' t achieve deep CBD cannulation although guidewire cannulation technique is used.The precutting techniques include precut papillotomy,transpancreatic precut sphincterotomy,needle-knife precut sphincterotomy and needle-knife fistulotomy.The standard endoscopic sphincterotomy would be performed after precut procedure if needed.Results:A total of 65 patients(39 male,26 female;19~78 years,53 years for mean) with difficult CBD cannulation underwent precutting technique.The procedure was successful in 54 of the patients(83.1%,54/65).The complications after precut procedure were hyperamylasemia(46.2%,30/65),mild acute pancreatitis(3.1%,2/65).No bleeding and perforation occurred after precut procedure in this study.Conclusions:Precut is an effective and safe technique in difficult biliary cannulation.It can be used in experienced hands when clinically indicated on therapeutic ERCP.