Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation

Background: Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation fails have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. Patients and Methods: Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm. Results: Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-precut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (precut, 2.4%, non-pre-cut, 3.9%; p > 0.05). Conclusion: Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.