Study On The Safety Of Early Transpancreatic Duct Precutting During ERCP Treatment

Objective To explore the therapeutic effectiveness and safety of early transpancreatic duct precutting in achieving cannulation of the common bile duct.Methods112patients who underwent ERCP from October2011to August2013met the selection criteria and were randomly assigned into2groups (on a1:3ratio): group A underwent precut times immediately after first-cannulation with guidewire sliding into pancreatic duct and group B underwent standard cannulation attempts for a total of15minutes. If success cannulation of the common bile duct was gained within this time and with pancreatic duct less than5times, patients were included in the group B1; otherwise, a precut procedure was carried out, and patients were included in the group B2.The success rates of biliary cannulation, the mean cannulation time, the mean x-ray exposure time, the complication rates related to the procedure and risk factors of post-ERCP pancreatitis were compared among these groups.Results The mean cannulation time and mean x-ray exposure time in group A were7.9min and5.8min,respectively,which were significantly lower than group B2(16.9min,10.4min).There were no differences between the two groups in the cannulation rates, but the post-ERCP pancreatitis rate was higher in group B2than in group A(26.9%vs.3.4%,P=0.02). Multivariate analysis indicated that risk factors of post-ERCP pancreatitis were more than10minutes of biliary cannulation attempts and more than2times cannulations of the pancreatic duct.Conclusion Early transpancreatic duct precutting is a safe and effective measure associated with lower pancreatitis rate.