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Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS pp 163–174Cite as

Biliary Sphincterotomy and Precut

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Abstract

The role of endoscopic retrograde cholangiopancreatography (ERCP) has changed through the years with an increasingly therapeutic purpose in patients with biliary disease. In this context, endoscopic sphincterotomy (EST) is a fundamental procedure.

There are several available accessories to perform EST that must be known by endoscopists, as well as the technique and possible complications of the procedure.

The most important step in ERCP is to achieve a common bile duct cannulation, which remains a challenge even for the most experienced endoscopists, with a failure rate of up to 10%. In these cases, an alternative technique is needed. Siegel first described the precut sphincterotomy with the use of needle-knife sphincterotome in 1980, and since that date the technique has evolved a lot and many variations and accessories have been introduced.

However, precut techniques remain a complex procedure with high risk of complications even for the most experienced endoscopists.

The purpose of this chapter is to focus on EST and precut techniques, equipment, outcomes, adverse events, as well as indications and contraindications.

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References

  1. Sriram PV, Rao GV, Nageshwar Reddy D. The precut—when, where and how? A review. Endoscopy. 2003;35(8):S24–30.

    CAS  PubMed  Google Scholar 

  2. Siegel JH. Precut papillotomy: a method to improve success of ERCP and papillotomy. Endoscopy. 1980;12:130–3.

    CAS  PubMed  Google Scholar 

  3. Neuhaus H. Biliary sphincterotomy. In: Baron TH, Kozarek RA, Carr-Locke DL, editors. ERCP. 3rd ed. Philadelphia: Elsevier; 2019. p. 137–47.

    Google Scholar 

  4. Schwacha H, Allgaier HP, Deibert P, et al. A sphincterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc. 2000;52:387–91.

    CAS  PubMed  Google Scholar 

  5. Cortas GA, Mehta SN, Abraham NS, et al. Selective cannulation of the common bile duct: a prospective randomized trial comparing standard catheters with sphincterotomes. Gastrointest Endosc. 1999;50:775–9.

    CAS  PubMed  Google Scholar 

  6. Cheung J, Tsoi KK, Quan WL, et al. Guidewire versus conventional contrast cannulation of the common bile duct for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Gastrointest Endosc. 2009;70:1211–9.

    PubMed  Google Scholar 

  7. Tse F, Yuan Y, Moayyedi P, et al. Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy. 2013;45:605–18.

    CAS  PubMed  Google Scholar 

  8. Halttunen J, Kylänpää L. A prospective randomized study of thin versus regular-sized guide wire in wire-guided cannulation. Surg Endosc. 2013;27:1662–6.

    PubMed  Google Scholar 

  9. Vihervaara H, Grönroos JM, Koivisto M, et al. Angled- or straight-tipped hydrophilic guidewire in biliary cannulation: a prospective, randomized, controlled trial. Surg Endosc. 2013;27:1281–6.

    PubMed  Google Scholar 

  10. Testoni PA, Mariani A, Aabakken L, et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2016;48:657–83.

    PubMed  Google Scholar 

  11. Rey JF, Beilenhoff U, Neumann CS, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: the use of electrosurgical units. Endoscopy. 2010;42:764–72.

    CAS  PubMed  Google Scholar 

  12. Tokar JL, Barth BA, et al. Electrosurgical generators. Gastrointest Endosc. 2013;78:197–208.

    PubMed  Google Scholar 

  13. Kohler A, Maier M, Benz C, et al. A new HF current generator with automatically controlled system (Endocut mode) for endoscopic sphincterotomy – preliminary experience. Endoscopy. 1998;30(4):351–5.

    CAS  PubMed  Google Scholar 

  14. Akiho H, Sumida Y, Akahoshi K, et al. Safety advantage of endocut mode over endoscopic sphincterotomy for choledocholithiasis. World J Gastroenterol. 2006;12:2086–8.

    PubMed  PubMed Central  Google Scholar 

  15. Perini RF, Sadurski R, Cotton PB, et al. Post-sphincterotomy bleeding after the introduction of microprocessor controlled electrosurgery: does the new technology make the difference? Gastrointest Endosc. 2005;61:53–7.

    PubMed  Google Scholar 

  16. Tanaka Y, Sato K, Tsuchida H, et al. A prospective randomized controlled study of endoscopic sphincterotomy with the endocut mode or conventional blended cut mode. J Clin Gastroenterol. 2015;49:127–31.

    PubMed  PubMed Central  Google Scholar 

  17. Parlak E, Koksal AS, Ozlas E, et al. Is there a safer electrosurgical current for endoscopic sphincterotomy in patients with liver cirrhosis? Wien Klin Wochenschr. 2016;128(15–16):573–8.

    PubMed  Google Scholar 

  18. Verma D, Kapadia A, Adler DG. Pure versus mixed electrosurgical current for endoscopic biliary sphincterotomy: a meta-analysis of adverse outcomes. Gastrointest Endosc. 2007;66(2):283–90.

    PubMed  Google Scholar 

  19. ERCP-related Adverse Events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2020;52(2):127–149. PMID: 31863440 https://doi.org/10.1055/a-1075-4080.

  20. Mavrogiannis C, Liatos C, Papanikolaou IS, et al. Safety of extension of a previous endoscopic sphincterotomy: a prospective study. Am J Gastroenterol. 2003;98(1):72–6.

    PubMed  Google Scholar 

  21. Ogura T, Higuchi K. A review of treatment options for bile duct stones. Expert Rev Gastroenterol Hepatol. 2016;10:1271–8.

    CAS  PubMed  Google Scholar 

  22. Easler JJ, Sherman S. Endoscopic retrograde cholangiopancreatography for the management of common bile duct stones and gallstone pancreatitis. Gastrointest Endosc Clin N Am. 2015;25:657–75.

    PubMed  Google Scholar 

  23. Franzini TA, Moura RN, de Moura EG. Advances in therapeutic cholangioscopy. Gastroenterol Res Pract. 2016;2016:5249152.

    PubMed  PubMed Central  Google Scholar 

  24. Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000;52:187–91.

    CAS  PubMed  Google Scholar 

  25. Sakai Y, Tsuyuguchi T, Hirata N. Can endoscopic sphincterotomy be performed safely in elderly patients aged 80 years or older with pancreatic and biliary diseases? Hepato-Gastroenterology. 2013;60(126):1251–6.

    PubMed  Google Scholar 

  26. Burstow MJ, Yunus RM, Hossain MB, et al. Meta-analysis of early endoscopic retrograde cholangiopancreatography (ERCP) ± endoscopic sphincterotomy (ES) versus conservative management for gallstone pancreatitis (GSP). Surg Laparosc Endosc Percutan Tech. 2015;25:185–203.

    PubMed  Google Scholar 

  27. Da Costa DW, Schepers NJ, Römkens TE. Endoscopic sphincterotomy and cholecystectomy in acute biliary pancreatitis. Surgeon. 2016;14:99–108.

    PubMed  Google Scholar 

  28. Cui PJ, Yao J, Zhao YJ, et al. Biliary stenting with or without sphincterotomy for malignant biliary obstruction: a meta-analysis. World J Gastroenterol. 2014;20:14033–9.

    PubMed  PubMed Central  Google Scholar 

  29. Hayashi T, Kawakami H, Osanai M, et al. No benefit of endoscopic sphincterotomy before biliary placement of self-expandable metal stents for unresectable pancreatic cancer. Clin Gastroenterol Hepatol. 2015;13:1151–8.

    PubMed  Google Scholar 

  30. Choudhary A, Bechtold ML, Arif M, et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc. 2011;73:275–82.

    PubMed  Google Scholar 

  31. Freeman ML. Preventing post-ERCP pancreatitis: update 2016. Curr Treat Options Gastroenterol. 2016;14:340–7.

    PubMed  Google Scholar 

  32. Freeman ML, Guptta K, Howell DA, Robson KM. Precut (access) papillotmy—Uptodate. https://www.uptodate.com/contents/precut-access-papillotomy. Access 18 Dec 2018.

  33. Mazaki T, Mado K, Masuda H, et al. Prophylactic pancreatic stent placement and post-ERCP pancreatitis: an updated meta-analysis. J Gastroenterol. 2014;49:343–55.

    PubMed  Google Scholar 

  34. Ferreira LE, Baron TH. Post-sphincterotomy bleeding: who, what, when, and how. Am J Gastroenterol. 2007;102:2850–8.

    PubMed  Google Scholar 

  35. Anderson MA, Fisher L, Jain R, et al. Complications of ERCP. Gastrointest Endosc. 2012;75:467–73.

    PubMed  Google Scholar 

  36. Parlak E, Dişibeyaz S, Köksal AŞ, et al. Factors affecting the success of endoscopic treatment of sphincterotomy bleeding. Clin Res Hepatol Gastroenterol. 2013;37:391–9.

    PubMed  Google Scholar 

  37. Enns R, Eloubeidi MA, Mergener K, et al. ERCP-related perforations: risk factors and management. Endoscopy. 2002;34:293–8.

    CAS  PubMed  Google Scholar 

  38. Sujievvan C, Gary M, Paul K. Access (precut) papillotomy. In: Baron TH, Kozarek RA, Carr-Locke DL, editors. ERCP. 3rd ed. Philadelphia: Elsevier; 2019. p. 123–31.

    Google Scholar 

  39. DaVee T, Garcia JA, Baron TH. Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatography. Ann Gastroenterol. 2012;25(4):291–302.

    PubMed  PubMed Central  Google Scholar 

  40. Freeman ML. Precut (access) sphincterotomy. Tech Gastrointest Endosc. 1999;49(5):580–6.

    CAS  Google Scholar 

  41. Carr-Locke DL. Biliary access during endoscopic retrograde cholangiopancreatography. Can J Gastroenterol. 2004;18:251–4.

    PubMed  Google Scholar 

  42. Mammen A, Haber G. Difficult biliary access: advanced cannulation and sphincterotomy technique. Gastrointest Endosc Clin N Am. 2015;25:619–30.

    PubMed  Google Scholar 

  43. Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc. 2005;61:112–25.

    PubMed  Google Scholar 

  44. Goff JS. Long-term experience with the transpancreatic sphincter pre-cut approach to biliary sphincterotomy. Gastrointest Endosc. 1999;50:642–5.

    CAS  PubMed  Google Scholar 

  45. Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc. 1995;41:502–5.

    CAS  PubMed  Google Scholar 

  46. Akashi R, Kiyozumi T, Jinnouchi K, Yoshida M, Adachi Y, Sagara K. Pancreatic sphincter precutting to gain selective access to the common bile duct: a series of 172 patients. Endoscopy. 2004;36:405–10.

    CAS  PubMed  Google Scholar 

  47. Baron TH. Complications of endoscopic biliary sphincterotomy: the first cut is the deepest. Clin Gastroenterol Hepatol. 2004;2(11):968–70.

    PubMed  Google Scholar 

  48. Weber A, Roesch T, Pointner S, et al. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: a safe and successful technique. Pancreas. 2008;36:187–91.

    PubMed  Google Scholar 

  49. Kapetanos D, Kokozidis G, Christodoulou D, et al. Case series of transpancreatic septotomy as precutting technique for difficult bile duct cannulation. Endoscopy. 2007;39:802–6.

    CAS  PubMed  Google Scholar 

  50. Sakai Y, Tsuyuguchi T, Sugiyama H, et al. Transpancreatic precut papillotomy in patients with difficulty in selective biliary cannulation. Hepato-Gastroenterology. 2011;58:1853–8.

    CAS  PubMed  Google Scholar 

  51. Loperfido S, Angelini G, Benedetti G, et al. Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998;48:1–10.

    CAS  PubMed  Google Scholar 

  52. Freeman ML, Guda NM. Prevention of post-ERCP pancreatitis: a comprehensive review. Gastrointest Endosc. 2004;59:845–64.

    PubMed  Google Scholar 

  53. Masci E, Mariani A, Curioni S, Testoni PA. Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy. 2003;35:830–4.

    CAS  PubMed  Google Scholar 

  54. Cennamo V, Fuccio L, Zagari RM, et al. Can early precut implementation reduce endoscopic retrograde cholangiopancreatography-related complication risk? Meta-analysis of randomized controlled trials. Endoscopy. 2010;42:381–8.

    CAS  PubMed  Google Scholar 

  55. Sundaralingam P, Masson P, Bourke MJ. Early precut sphincterotomy does not increase risk during endoscopic retrograde cholangiopancreatography in patients with difficult biliary access: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol. 2015;13:1722–9.

    PubMed  Google Scholar 

  56. Navaneethan U, Konjeti R, Venkatesh PG, et al. Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: an updated meta-analysis. World J Gastrointest Endosc. 2014;6:200–8.

    PubMed  PubMed Central  Google Scholar 

  57. Choudhary A, Winn J, Siddique S, et al. Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis: a systematic review and meta-analysis. World J Gastroenterol. 2014;20:4093–101.

    PubMed  PubMed Central  Google Scholar 

  58. Navaneethan U, Konjeti R, Lourdusamy V, et al. Precut sphincterotomy: efficacy for ductal access and the risk of adverse events. Gastrointest Endosc. 2015;81:924–31.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Unit of Gastroenterology and Operative Digestive Endoscopy, Maggiore-Bellaria Hospital, AUSL Bologna, Bologna, Italy

    Vincenzo Cennamo, Marco Bassi, Stefano Landi & Stefania Ghersi

Authors
  1. Vincenzo Cennamo
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  2. Marco Bassi
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  3. Stefano Landi
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  4. Stefania Ghersi
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Corresponding author

Correspondence to Vincenzo Cennamo .

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Editors and Affiliations

  1. Digestive and Interventional Endoscopy Unit, Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore, Milano, Italy

    Massimiliano Mutignani

  2. Hepatologie und Endokrinologie, Abteilung für Gastroenterologie, Robert-Bosch-Krankenhaus, Auerbachstraße, Stuttgart, Germany

    Jörg G. Albert

  3. Department of Gastroenterology, Azienda USL di Forlì-Cesena, Bologna, Italy

    Carlo Fabbri

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Cennamo, V., Bassi, M., Landi, S., Ghersi, S. (2020). Biliary Sphincterotomy and Precut. In: Mutignani, M., Albert, J.G., Fabbri, C. (eds) Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS. Springer, Cham. https://doi.org/10.1007/978-3-030-42569-2_14

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  • DOI: https://doi.org/10.1007/978-3-030-42569-2_14

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