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

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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.

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Disclosures

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

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Authors and Affiliations

  1. Digestive Endoscopy Center, Department of Gastroenterology, Runjin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China

    Biao Gong & Like Bie

  2. Department of Hepatobiliary Surgery, The 455st Hospital of Chinese People’s Liberation Army, 338 Huaihai Xi Road, Shanghai, 200052, China

    Lixiao Hao

  3. Department of Gastroenterology, Shanghai Gleneagles Medical Center, Parkwany Health (China and North Asia), 389 Nanjing Xi Road, Shanghai, 200003, China

    Bo Sun

  4. Department of Oncology, Changai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

    Mei Wang

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  1. Biao Gong
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  2. Lixiao Hao
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  3. Like Bie
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  4. Bo Sun
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  5. Mei Wang
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Corresponding author

Correspondence to Mei Wang.

Additional information

Lixiao Hao contributed equally to Biao Gong.

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Gong, B., Hao, L., Bie, L. et al. Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials. Surg Endosc 24, 2670–2680 (2010). https://doi.org/10.1007/s00464-010-1033-y

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