Meta-Analysis
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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
Processing time: 240 Days and 16.5 Hours
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.