Precut sphincterotomy: Efficacy for ductal access and the risk of adverse events

Background Successful ductal access is achieved in 90% of patients who undergo ERCP. Precut sphincterotomy has been advocated when routine cannulation is not possible. Objective To evaluate the efficacy of precut sphincterotomy for ductal access and the risk of adverse events including post-ERCP pancreatitis (PEP) associated with it. Design Retrospective analysis of ERCP procedures performed from 2002 to 2011. Setting Referral center. Patients A total of 10,202 consecutive patients who underwent native cannulation ERCP. Main Outcome Measurements Efficacy for ductal access and risk of adverse events including PEP. Results A total of 706 patients required precut sphincterotomy, 614 of whom (86.9%) had successful biliary cannulation. PEP was diagnosed in 58 (8.2 %), perforation in 6 (0.8%), and bleeding in 49 (6.9%) patients. On multivariate analysis, unsuccessful precut sphincterotomy (odds ratio [OR] 2.59; 95% confidence interval [CI], 1.53-4.40; P <.001) and female sex (OR 1.95; 95% CI, 1.23-3.07; P =.004) were associated with increased risk of the development of adverse events. Female sex (OR 2.42; 95% CI, 1.29-4.55; P =.006) and sphincter of Oddi dysfunction (OR 2.77; 95% CI, 1.16-6.60; P =.02) were associated with an increased risk of PEP. Limitations Retrospective study. Conclusions Precut sphincterotomy is effective in achieving ductal access when standard cannulation techniques fail. A successful precut sphincterotomy is not associated with an increased risk of adverse events.