Navaneethan U, Konjeti R, Venkatesh PG, Sanaka MR, Parsi MA. Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: An updated meta-analysis. World J Gastrointest Endosc 2014; 6(5): 200-208 [PMID: 24891933 DOI: 10.4253/wjge.v6.i5.200]
Corresponding Author of This Article
Mansour A Parsi, MD, MPH, Head, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States. parsim@ccf.org
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. May 16, 2014; 6(5): 200-208 Published online May 16, 2014. doi: 10.4253/wjge.v6.i5.200
Early precut sphincterotomy and the risk of endoscopic retrograde cholangiopancreatography related complications: An updated meta-analysis
Udayakumar Navaneethan, Rajesh Konjeti, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi
Udayakumar Navaneethan, Preethi GK Venkatesh, Madhusudhan R Sanaka, Mansour A Parsi, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Rajesh Konjeti, Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, United States
Author contributions: Navaneethan U contributed to study concept, design, and paper revisions; Konjeti R contributed to study concept, design, paper preparation and statistical analysis; Venkatesh PGK contributed to paper preparation; Sanaka MR and Parsi MA contributed to paper preparation and critical revisions.
Correspondence to: Mansour A Parsi, MD, MPH, Head, Section for Advanced Endoscopy and Pancreatobiliary Disorders, Department of Gastroenterology, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, United States. parsim@ccf.org
Telephone: +1-216-4444880 Fax: +1-216-44446305
Received: September 21, 2013 Revised: March 12, 2014 Accepted: April 25, 2014 Published online: May 16, 2014
Core Tip
Core tip: Selective cannulation of the bile duct remains the limiting step in therapeutic post-endoscopic retrograde cholangiopancreatography (ERCP). Greater than 90% of cannulation is achieved through standard techniques. In 10% of patients, cannulation is difficult and requires additional techniques such as pre-cut sphincterotomy. Early use of pre-cut sphincterotomy is suggested as a means to prevent excessive and repetitive papillary trauma which may in turn increase the risk of post-ERCP pancreatitis. The use of pre-cut sphincterotomy has been considered to increase risk of post-ERCP complications, in particular post-ERCP pancreatitis. We studied the literature on the use of pre-cut sphincterotomy in biliary access. Our meta-analysis showed that pre-cut sphincterotomy and persistent attempts at cannulation are comparable in terms of overall complication rates including post-ERCP pancreatitis. Early pre-cut implementation does not increase PEP complications.
