Timing of precut procedure does not influence success rate and complications of ERCP procedure: a prospective randomized comparative study

BackgroundThere is scarce information on whether performing the precut procedure early rather than after several cannulation attempts is associated with different success and complication rates.ObjectiveTo compare the success and complication rates of precutting implemented either early or after prolonged attempts by the standard approach.DesignSingle-center prospective randomized study.SettingTertiary care center.PatientsOver the 2-year study period, 1078 therapeutic ERCP procedures were performed. One hundred forty-six patients (mean age 68.5 years [range: 34-88 years], 67 men and 79 women) met the selection criteria and were randomized into 2 groups (on a 1:3 basis): group A underwent precut immediately after randomization (36 patients) and group B underwent standard cannulation attempts for a further 20 minutes followed by needle-knife precut in case of failure (110 patients).Main Outcome MeasurementsDeep biliary cannulation and the incidence of post-ERCP complications.ResultsThe precut procedure performed in group A allowed deep cannulation of the common bile duct in 33 of 36 patients (92%). In group B, cannulation was successfully achieved in 104 of 110 patients (95%). Among group B patients, biliary cannulation was achieved with the standard approach in 78 patients, whereas precutting was performed in 32 patients, and deep cannulation was achieved in 26 of them. The overall complication rate was 8% (3/36) in group A and 6% (7/110) in group B.LimitationsSmall sample size.ConclusionsTiming of pre-cutting does not appear to influence success and complication rates of ERCP procedures.