Precut Sphincterotomy is a Valuable Advanced Cannulation Technique for Difficult Biliary Duct Cannulation in Single-Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for Surgically Altered Anatomy.

BACKGROUND

In single balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography (SBE-assisted ERCP) for patients with surgically altered anatomies, precut sphincterotomy is performed as an advanced cannulation technique for difficult biliary cannulation cases. This study evaluated the safety and efficacy of precut sphincterotomy.

METHODS

The study included patients who underwent SBE-assisted ERCP on a naive papilla with surgically altered anatomies (excluding Billroth-I reconstruction) from April 2015 to December 2023. The success rate of biliary cannulation and the complication incidence were analyzed retrospectively.

RESULTS

A total of 231 patients were included. Scope insertion to the duodenal papilla was possible in 204 cases (88.3%), and biliary cannulation was attempted in 198 cases (85.7%). Standard cannulation was successful in 132 cases (66.7%), while an additional 10 cases (5.1%) successfully cannulated using pancreatic guide wire-assisted biliary cannulation. An additional 28 cases (14.1%) were successfully cannulated using precut sphincterotomy. Therefore, the overall biliary cannulation success rate was 85.9% (170 of 198 cases). The success rate of precut sphincterotomy was 66.7% (28 of 42 cases). Intraoperative bleeding caused by precut sphincterotomy occurred in 11.9%, and other complications were present in 16.7% of cases.

CONCLUSIONS

Precut sphincterotomy is a one of the valuable techniques in SBE-assisted ERCP for surgically altered anatomies.