Journal of Gastrointestinal Surgery

, Volume 14, Issue 4, pp 697–704 | Cite as

Success and Complication Rates of Two Precut Techniques, Transpancreatic Sphincterotomy and Needle-Knife Sphincterotomy for Bile Duct Cannulation

  • Peng Wang
  • Wei Zhang
  • Feng Liu
  • Zhao-Shen LiEmail author
  • Xu Ren
  • Zhi-Ning Fan
  • Xiao Zhang
  • Nong-Hua Lu
  • Wen-Sheng Sun
  • Rui-Hua Shi
  • Yan-Qing Li
  • Qiu Zhao
Original Article



The majority of literature on the precut technique is concerned with needle-knife sphincterotomy, whereas the comparison of transpancreatic sphincterotomy and needle-knife sphincterotomy has been rarely reported.


The aim of the study was to compare the success and the complication rates of transpancreatic sphincterotomy with needle-knife sphincterotomy.


During May 2006 and April 2007, 3,178 consecutive endoscopic retrograde cholangiopancreatography (ERCP) procedures were performed in a prospective multicenter study on ERCP-related complications. From the files of these patients, data of cases undergoing precut sphincterotomy, including transpancreatic sphincterotomy and needle-knife sphincterotomy, were retrospectively extracted and analyzed.


Overall, 216 patients with precut sphincterotomy were identified; 140 cases received transpancreatic sphincterotomy, and 76 received needle-knife sphincterotomy. There was no significant difference in the initial and eventual success rates between transpancreatic and needle-knife sphincterotomy (82.9% vs. 90.8% and 90.0% vs. 90.8%, respectively). The overall incidences of complications and acute pancreatitis were not significantly different between the two groups (14.3% vs. 18.4% and 11.4% vs. 11.8%, respectively).


Transpancreatic precut sphincterotomy results in similar success and complication rates when compared with needle-knife sphincterotomy. This new precut technique seems to be a safe alternative to needle-knife sphincterotomy with reasonable success rates. However, prospective randomized controlled studies are required to verify our findings.


Transpancreatic sphincterotomy Needle-knife sphincterotomy Biliary cannulation Endoscopic retrograde cholangiopancreatography (ERCP) 



We would like to thank all those endoscopists and physicians who assisted in data collection. This study was partially supported by a grant from Boston Scientific Corporation, China.

Competing interests



  1. 1.
    Siegel JH, Ben-Zvi JS, Pullano W. The needle knife: a valuable tool in diagnostic and therapeutic ERCP. Gastrointest Endosc 1989;35(6):499–503CrossRefPubMedGoogle Scholar
  2. 2.
    Freeman ML, Guda NM. ERCP cannulation: a review of reported techniques. Gastrointest Endosc 2005;61(1):112–125.CrossRefPubMedGoogle Scholar
  3. 3.
    Siegel JH. Precut papillotomy: a method to improve success of ERCP and papillotomy. Endoscopy 1980;12(3):130–133.CrossRefPubMedGoogle Scholar
  4. 4.
    Huibregtse K, Katon RM, Tytgat GN. Precut papillotomy via fine-needle knife papillotome: a safe and effective technique. Gastrointest Endosc 1986;32(6):403–405.CrossRefPubMedGoogle Scholar
  5. 5.
    Dowsett JF, Polydorou AA, Vaira D, D’Anna LM, Ashraf M, Croker J, Salmon PR, Russell RC, Hatfield AR. Needle knife papillotomy: how safe and how effective? Gut 1990;31(8):905–908.CrossRefPubMedGoogle Scholar
  6. 6.
    Boender J, Nix GA, de Ridder MA, van Blankenstein M, Schutte HE, Dees J, Wilson JH. Endoscopic papillotomy for common bile duct stones: factors influencing the complication rate. Endoscopy 1994;26(2):209–216.CrossRefPubMedGoogle Scholar
  7. 7.
    Gholson CF, Favrot D. Needle knife papillotomy in a university referral practice. Safety and efficacy of a modified technique. J Clin Gastroenterol 1996;23(3):177–180.CrossRefPubMedGoogle Scholar
  8. 8.
    Rabenstein T, Ruppert T, Schneider HT, Hahn EG, Ell C. Benefits and risks of needle-knife papillotomy. Gastrointest Endosc 1997;46(3):207–211.CrossRefPubMedGoogle Scholar
  9. 9.
    Harewood GC, Baron TH. An assessment of the learning curve for precut biliary sphincterotomy. Am J Gastroenterol 2002;97(7):1708–1712.CrossRefPubMedGoogle Scholar
  10. 10.
    Katsinelos P, Mimidis K, Paroutoglou G, Christodoulou K, Pilpilidis I, Katsiba D, Kalomenopoulou M, Papagiannis A, Tsolkas P, Kapitsinis I, Xiarchos P, Beltsis A, Eugenidis N. Needle-knife papillotomy: a safe and effective technique in experienced hands. Hepatogastroenterology 2004;51(56):349–352.PubMedGoogle Scholar
  11. 11.
    Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc 1995;41(5):502–505.CrossRefPubMedGoogle Scholar
  12. 12.
    Weber A, Roesch T, Pointner S, Born P, Neu B, Meining A, Schmid RM, Prinz C. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: a safe and successful technique. Pancreas 2008;36(2):187–191.CrossRefPubMedGoogle Scholar
  13. 13.
    Catalano MF, Linder JD, Geenen JE. Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: Comparison with standard pre-cut papillotomy. Gastrointest Endosc 2004;60(4):557–561.CrossRefPubMedGoogle Scholar
  14. 14.
    Kapetanos D, Kokozidis G, Christodoulou D, Mistakidis K, Dimakopoulos K, Katodritou E, Kitis G, Tsianos EV. Case series of transpancreatic septotomy as precutting technique for difficult bile duct cannulation. Endoscopy 2007;39(9):802–806.CrossRefPubMedGoogle Scholar
  15. 15.
    Halttunen J, Keranen I, Udd M, Kylanpaa L. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 2009;23(4):745–749.CrossRefPubMedGoogle Scholar
  16. 16.
    Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN, Huang Q, Zhang X, He LP, Sun WS, Zhao Q, Shi RH, Tian ZB, Li YQ, Li W, Zhi FC. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol 2009;104(1):31–40.CrossRefPubMedGoogle Scholar
  17. 17.
    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(5):405–410.CrossRefPubMedGoogle Scholar
  18. 18.
    Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, Liguory C, Nickl N. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37(3):383–393.CrossRefPubMedGoogle Scholar
  19. 19.
    Goff JS. Long-term experience with the transpancreatic sphincter pre-cut approach to biliary sphincterotomy. Gastrointest Endosc 1999;50(5):642–645.CrossRefPubMedGoogle Scholar
  20. 20.
    Kahaleh M, Tokar J, Mullick T, Bickston SJ, Yeaton P. Prospective evaluation of pancreatic sphincterotomy as a precut technique for biliary cannulation. Clin Gastroenterol Hepatol 2004;2(11):971–977.CrossRefPubMedGoogle Scholar
  21. 21.
    Freeman ML, Nelson DB, Sherman S, Haber GB, Herman ME, Dorsher PJ, Moore JP, Fennerty MB, Ryan ME, Shaw MJ, Lande JD, Pheley AM. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996;335(13):909–918.CrossRefPubMedGoogle Scholar
  22. 22.
    Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Bjorkman DJ, Overby CS, Aas J, Ryan ME, Bochna GS, Shaw MJ, Snady HW, Erickson RV, Moore JP, Roel JP. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54(4):425–434.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Peng Wang
    • 1
  • Wei Zhang
    • 1
  • Feng Liu
    • 1
  • Zhao-Shen Li
    • 1
    Email author
  • Xu Ren
    • 2
  • Zhi-Ning Fan
    • 3
  • Xiao Zhang
    • 4
  • Nong-Hua Lu
    • 5
  • Wen-Sheng Sun
    • 6
  • Rui-Hua Shi
    • 7
  • Yan-Qing Li
    • 8
  • Qiu Zhao
    • 9
  1. 1.Department of Gastroenterology, Changhai HospitalSecond Military Medical UniversityShanghaiChina
  2. 2.Heilongjiang Provincial HospitalHarbinChina
  3. 3.The Second Affiliated Hospital of Nanjing Medical UniversityNanjingChina
  4. 4.The First People’s Hospital of HangzhouHangzhouChina
  5. 5.The First Affiliated Hospital of Nanchang UniversityNanchangChina
  6. 6.Shandong Communication HospitalJinanChina
  7. 7.The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
  8. 8.Qilu HospitalShandong UniversityJinanChina
  9. 9.Tongji Hospital, Tongji Medical CollegeHuazhong University of Science & TechnologyWuhanChina

Personalised recommendations