[Precut Vater's papilla. Prospective evaluation of frequency of use, effectiveness, complication and mortality. Cooperative study in the northwest of the province of Buenos Aires].

INTRODUCTION

Precut papillotomy, has been considered a potentially dangerous procedure. In spite of this, numerous national and foreign referral centers have reported good results with the use of this technique that increases the cannulation rate and permits additional therapeutic procedures.

OBJECTIVES

We evaluated the procedure in terms of frequency of use, effectiveness, complications and mortality.

PATIENT AND METHODS

Between January 1, 1996 and December 31, 1999, 419 ERCP were performed in our centers. We used precut papillotomy in 51 patients. Inclusion criteria for precut papillotomy protocol were: 1 precut papillotomy indication. 1-1 failure to cannulate the papilla, 1-2 appropriate indication, 1-3 Expert endoscopist, 2 complete follow up, 3 informed consent. The experimental design of the study was prospective. When the patients entered into the protocol, they underwent a needle-knife sphincterotomy according to Huibregise's technique. The follow up was done during 30 days, with a clinical examination, laboratory test and ultrasonography all of them weekly, to determine the possible complications according to Cotton's criteria and the mortality.

RESULTS

4-1) Precut frequency: 51 patients (pts.) (12.1%). 4-2) Follow up: 49 pts. (96.1%) fulfilled the weekly controls; 2 pts. (3.9%) did not come for the controls. 4-3) Sex and Age: Women 29 pts. (56.9%). Age 62.5 +/- 1.74 years. Men: 22 pts. (43.1%) Age +/- 3.35 years. 4-4) INDICATIONS: Jaundice, diagnosis and treatment: 44 pts. (86.3%), post-cholecystectomy pain; 4 pts. (7.8%), and idiopathic abdominal pain: 3 pts. (5.9%). 4-5) Effectiveness: First attempt 35 pts. (71.4%), second attempt: 10 pts (20.4%). Definite effectiveness: 45 pts. (98.1%), failure: 4 pts. (8.1%). 4-6) Complementary treatment: in 43 pts. we performed the following procedures: papillotomy and stone extraction: 26 pts. (53%), papillotomy and prosthesis: 9 pts. (18.4%), Prosthesis: 8 pts. (16.3%, only pre-cut papillotomy: 6 pts. (12.2%). 4-7 Final diagnoses: Coledocholithiasis 41 pts. (83.6%); Malignant obstruction of biliary duct: 4 pts. (8.2%), Pancreatic Cancer: 1 pts. (2%); Ampullary Cancer 1 pts. (2%). Oddi sphyncter dysfunction: 1 pts. (2%). 4-8.

COMPLICATIONS

Total 9 pts. (18.4%). mild Haemorrhage: 7 pts. (14.4%). Acute pancreatitis: 2 pts. (4%), mild: 1 pts. (2%), severe: 1 pts. (2%) 4-9-Mortality: not recorded.

CONCLUSIONS

5-1 Precut papillotomy is used by us with the same frequency native authors use it, but less than foreign authors. 5-2 Age, sex, indications, complementary treatment and final diagnoses are similar to those repo. 5-3 reported by other authors. 5-3- High rate of follow up. 5-4- High percentage of effectiveness which coincide with consulted studies. Precut papillotomy was the only therapy in 12.2% of the cases. 5-5 Low percentage of complications and, when present, of minor importance coinciding with other authors. 5-6 No mortality. 5-7 In our experience, precut papillotomy was a safe and effective technique to cannulate the papilla.