Safety and success of precut biliary sphincterotomy: Is it linked to experience or expertise?

Table 1 Indications for precut and standard biliary sphincterotomy

Indication	PBS (%)	ES (%)	1P
	n = 150	n = 818
Stones	27	35	0.04a
Malignancy	15	3	< 0.001c
Biliary dilatation	15	10	0.07
Stricture	11	2	< 0.001c
Bile leak	9	4	0.006b
Pancreatitis	8	15	0.017a
Jaundice	5	3	0.36
Stent	1	6	0.19
Elevated LFTs	2	2	0.74
Cholangitis	1	1	1.00
r/o SOD	1	8	0.002b

^aP < 0.5,

^bP < 0.01,

^cP < 0.001 expressed as PBS vs ES using Chi-square (or Fisher’s exact test where appropriate). PBS: precut biliary sphincterotomy; ES: endoscopic sphincterotomy.

Table 2 Complications: ES vs PBS

	ES (%)	PBS (%)	P
Pancreatitis	2.7	4	0.38
Bleeding	1.3	2.7	0.23
Infection	0.5	0	0.39
Perforation	0.1	0	0.67
Total	4.6	6.7	0.29

PBS: precut biliary sphincterotomy; ES: endoscopic sphincterotomy.

Table 3 One hundred and fifty precuts performed in the 6 groups during the study period

	Group 1 (%)	Group 2 (%)	Group 3 (%)	Group 4 (%)	Group 5 (%)	Group 6 (%)	Total(%)
1º success	64	68	76	80	76	84	74.7
2º success	20	16	12	8	12	8	12.7
Total success	84	84	88	88	88	921	87.3
Complications	8	8	16	4	0	4	6.7
PD stent	20	28	24	28	48	16	27.3

¹Indicates the success rates compared in the discussion. 1^o success: successful cannulation of the duct at the first attempt; 2^o success: successful cannulation of the duct at a subsequent attempt. PD: pancreatic duct.