Early precut is useful for difficult bile duct cannulation, particularly in cases with long oral protrusion

Table 9 Comparison of treatment outcomes between the early precut and other advanced cannulation technique groups, limited to cases of oral protrusion-large, n (%)

Outcomes	Early precut (n = 35)	Other ACTs (n = 23)	P value
Overall bile duct cannulation success rate	97.1% (34/35)	100% (23/23)	1.0
Success rate up to the 2nd line	97.1% (34/35)	65.2% (15/23)	0.001
Cannulation time (second)	757.5 (242-2085)	1764 (305-3437)	< 0.001
No. of attempts	7 (2-15)	10 (3-20)	< 0.001
Procedure time (minute)	30 (10-69)	58 (30-135)	0.007
Complications	3 (8.6)	10 (43.5)	0.003
Hemorrhage	0	1 (4.3) (mild)	0.40
PEP	1 (2.9)	4 (17.4)	0.075
Mild/moderate/severe	1/0/0	2/1/1	-
Elevated amylase	2 (5.7)	5 (21.7)	0.10
Amy level Median (range, U/L)	110 (20-895)	193 (39-2632)	0.021

ACTs: Advanced cannulation techniques; PEP: Post endoscopic retrograde cholangiopancreatography pancreatitis; Amy: Serum amylase.