Advertisement

Surgical Endoscopy

, Volume 24, Issue 11, pp 2670–2680 | Cite as

Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials

  • Biao Gong
  • Lixiao Hao
  • Like Bie
  • Bo Sun
  • Mei Wang
Review

Abstract

Background

There is no clear answer regarding use of precut technique versus conventional method in achieving successful biliary cannulation.

Objective

To compare the effectiveness of precut technique with that of conventional biliary cannulation by meta-analysis of available randomized controlled trials (RCTs).

Methods

Databases including MEDLINE, EMBASE, Cochrane Library, and Science Citation Index updated to July 2009 were searched. Main outcome measures were success rates of biliary cannulation, incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications, and post-ERCP pancreatitis rate. Meta-analysis of these clinical trials was performed.

Results

Six RCTs were included. The primary biliary cannulation rate reported with precut and conventional techniques was 89.3 and 78.1%, respectively. Pooled analysis of all selected studies comparing precut cannulation technique with conventional techniques yielded an odds ratio (OR) of 2.05 [95% confidence interval (CI): 0.64–6.63]. Pooled analysis comparing post-ERCP pancreatitis rates for the precut-cannulation groups with those for the conventional-method groups yielded an rate ratio (RR) of 0.46 (95% CI: 0.23–0.92).

Conclusion

This meta-analysis shows that the precut technique does not increase the primary cannulation rate. However, the technique reduces the risk of post-ERCP pancreatitis compared with conventional technique. Further large, well-performed, randomized controlled studies are needed to confirm these findings.

Keywords

Endoscopic retrograde cholangiopancreatography Precut endoscopic biliary sphincterotomy Cannulation Common bile duct Complications Meta-analysis 

Notes

Disclosures

Drs. Lixiao Hao, Biao Gong, Like Bie, and Bo Sun have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Freeman ML, Guda NM (2005) ERCP cannulation: a review of reported techniques. Gastrointest Endosc 61:112–125CrossRefPubMedGoogle Scholar
  2. 2.
    Cotton PB (1989) Precut sphincterotomy a risky technique for the experts only. Gastrointest Endosc 35:578–579CrossRefPubMedGoogle Scholar
  3. 3.
    Sriram PV, Rao GV, Nageshwar Reddy D (2003) The precut-when, where and how? A review. Endoscopy 35:S24–S30CrossRefPubMedGoogle Scholar
  4. 4.
    Tang SJ, Haber GB, Kortan P, Zanati S, Cirocco M, Ennis M, Elfant A, Scheider D, Ter H, Dorais J (2005) Precut papillotomy versus persistence in difficult biliary cannulation: a prospective randomized trial. Endoscopy 37:58–65CrossRefPubMedGoogle Scholar
  5. 5.
    Zhou PH, Yao LQ, Xu MD, Zhong YS, Gao WD, He GJ, Zhang YQ, Chen WF, Qin XY (2006) Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int 5:590–594PubMedGoogle Scholar
  6. 6.
    de Weerth A, Seitz U, Zhong Y, Groth S, Omar S, Papageorgiou C, Bohnacker S, Seewald S, Seifert H, Binmoeller KF, Thonke F, Soehendra N (2006) Primary precutting versus conventional over-the-wire sphincterotomy for bile duct access: a prospective randomized study. Endoscopy 38:1235–1240CrossRefPubMedGoogle Scholar
  7. 7.
    Khatibian M, Sotoudehmanesh R, Ali-Asgari A, Movahedi Z, Kolahdoozan S (2008) Needle-knife fistulotomy versus standard method for cannulation of common bile duct: a randomized controlled trial. Arch Iranian Med 11:16–20Google Scholar
  8. 8.
    Cennamo V, Fuccio L, Repici A, Fabbri C, Grilli D, Conio M, D’Imperio N, Bazzoli F (2009) Timing of precut procedure does not influence success rate and complications of ERCP procedure: a prospective randomized comparative study. Gastrointest Endosc 69:473–479CrossRefPubMedGoogle Scholar
  9. 9.
    Manes G, Di Giorgio P, Repici A, Macarri G, Ardizzone S, Porro GB (2009) An analysis of the factors associated with the development of complications in patients undergoing precut sphincterotomy: a prospective, controlled, randomized, multicenter study. Am J Gastroenterol, advance online publication, 23 June 2009; doi: 10.1038/ajg.2009.345
  10. 10.
    Meade MO, Richardson WS (1997) Selecting and appraising studies for a systematic review. Ann Intern Med 127:531–537PubMedGoogle Scholar
  11. 11.
    Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N (1991) Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 37:383–393CrossRefPubMedGoogle Scholar
  12. 12.
    Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273:408–412Google Scholar
  13. 13.
    Begg CB (1994) Publication bias. In: Cooper H, Hedges LV (eds) The Handbook of research synthesis. Russell Sage Foundation, New York, NY, pp 399–410Google Scholar
  14. 14.
    Cortas GA, Mehta SN, Abraham NS, Barkun AN (1999) Selective cannulation of the common bile duct: a prospective randomized trial comparing standard catheters with sphincterotomes. Gastrointest Endosc 50:775–779CrossRefPubMedGoogle Scholar
  15. 15.
    Schwacha H, Allgaier HP, Deibert P, Olschewski M, Allgaier U, Blum HE (2000) A sphicterotome-based technique for selective transpapillary common bile duct cannulation. Gastrointest Endosc 52:387–391CrossRefPubMedGoogle Scholar
  16. 16.
    Larkin CJ, Huibregtse K (2001) Precut sphincterotomy: indications, pitfalls, and complications. Curr Gastroenterol Rep 3:147–153CrossRefPubMedGoogle Scholar
  17. 17.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918CrossRefPubMedGoogle Scholar
  18. 18.
    Loperfido S, Angelini G, Benedetti G, Chilovi F, Costan F, De Berardinis F, De Bernardin M, Ederle A, Fina P, Fratton A (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48:1–10CrossRefPubMedGoogle Scholar
  19. 19.
    Masci E, Toti G, Mariani A, Curioni S, Lomazzi A, Dinelli M, Minoli G, Crosta C, Comin U, Fertitta A, Prada A, Passoni GR, Testoni PA (2001) Complications of diagnostic and therapeutic ERCP: a prospective multicenter study. Am J Gastroenterol 96:417–423CrossRefPubMedGoogle Scholar
  20. 20.
    Freeman ML, Guda NM (2005) ERCP cannulation: a review of reported techniques. Gastrointest Endosc 62:669–674CrossRefGoogle Scholar
  21. 21.
    Freeman ML (2002) Adverse outcomes of ERCP [review]. Gastrointest Endosc 56:S273–S282CrossRefPubMedGoogle Scholar
  22. 22.
    Masci E, Mariani A, Curioni S, Testoni PA (2003) Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopy 35:830–834CrossRefPubMedGoogle Scholar
  23. 23.
    Mavrogiannis C, Liatsos C, Romanos A, Petoumenos C, Nakos A, Karvountzis G (1995) Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones. Gastrointest Endosc 50:334–339CrossRefGoogle Scholar
  24. 24.
    Catalano MF, Linder JD, Geenen JE (2004) Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: comparison with standard pre-cut papillotomy. Gastrointest Endosc 60:557–561CrossRefPubMedGoogle Scholar
  25. 25.
    Halttunen J, Keränen I, Udd M, Kylänpää L (2009) Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 23:745–749CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Biao Gong
    • 1
  • Lixiao Hao
    • 2
  • Like Bie
    • 1
  • Bo Sun
    • 3
  • Mei Wang
    • 4
  1. 1.Digestive Endoscopy Center, Department of Gastroenterology, Runjin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
  2. 2.Department of Hepatobiliary SurgeryThe 455st Hospital of Chinese People’s Liberation ArmyShanghaiChina
  3. 3.Department of GastroenterologyShanghai Gleneagles Medical Center, Parkwany Health (China and North Asia)ShanghaiChina
  4. 4.Department of Oncology, Changai HospitalSecond Military Medical UniversityShanghaiChina

Personalised recommendations