Pancreatic sphincter precutting to gain selective access to the common bile duct: A series of 172 patients

Background and Study Aims: Several precutting techniques have been described in cases of failed access to the common bile duct. We describe our experience with pancreatic sphincter precutting in an upward direction, and report its success rates and complications. Patients and Methods: A total of 172 patients underwent a procedure using this technique between January 1989 and December 2001. The technique consisted of a medium-to-large precut along the midline, above the papillary elevation, using either the common channel or the pancreatic duct in the ampulla of Vater as a guide. The septum between the pancreatic duct and the bile duct was removed and separate openings to the pancreatic and bile ducts were created, followed by complete biliary sphincterotomy. Results: Biliary cannulation and sphincterotomy was successful in 163 of the 172 study patients (95%). Mild complications, which were all managed conservatively, occurred in 17 patients (10%). This complication rate was significantly higher than our complication rate for standard endoscopic sphincterotomy, which was 0.8% in 1770 patients (P < 0.0001). Conclusions: Pancreatic sphincter precutting is an effective and safe technique for patients in whom selective cannulation of the common bile duct has failed. Further prospective comparative studies of other precutting techniques will better define its clinical value.