Abstract
Learning Curve for Standard and Precut Sphincterotomy
Dr Thawatchai Akaraviputh
Mahidol University
Access into pancreatic duct (PD) or common bile duct (CBD) is paramount to success of diagnostic and therapeutic endoscopic retrograde cholongiopancreatography (ERCP). The common method of cannulation is employment of catheter over a guidewire. Selective CBD cannulation may be difficult in those with obstructive pathology. Overall success rates of CBD cannulation in patients with cholestasis by this method range from 71% to 82%, even when performed by experienced endoscopists. Precut sphincterotomy is a technique using to facilitate CBD cannulation by cutting the papilla prior to passing the guidewire into CBD. However, precut sphincterotomy is associated with higher intraoperative and postoperative complications comparing to non-precutting method. There is a few study on the correlation between endoscopist’s experience and outcomes of precut sphincterotomy.
In summary, the use of precut sphincterotomy for difficult biliary cannulation is safe and effective when standard techniques failed. The success rates of CBD cannulation after precut sphincterotomy were not associated with endoscopist’s experience. However, the post-procedure complications significantly decreased after the experience of 100 cases. Our data shows that at least 100 precut sphincterotomies are needed to effectively and safely perform this procedure.
