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Safety of Erlangen Precut Papillotomy

An Analysis of 1044 Consecutive ERCP Examinations in a Single Institution

Palm, Jukka, MD; Saarela, Arto, MD; Mäkelä, Jyrki, MD

Journal of Clinical Gastroenterology: May-June 2007 - Volume 41 - Issue 5 - p 528-533
doi: 10.1097/MCG.0b013e31802b8728
Liver, Pancreas and Biliary Tract: Clinical Research

Goals and Background There is controversy about the ideal utilization of precut papillotomy in endoscopic retrograde cholangiopancreatography examinations. Almost all reports in the literature concentrate on needle knife precut papillotomy, reporting a wide range of complications. We have used Erlangen precut papillotomy in our institution and our aim was to compare the safety of Erlangen precut papillotomy to standard free cannulation technique. The influence of precutting on the deep biliary cannulation rate was also recorded.

Study Over a period of 48 months a total of 602 out of 1044 consecutive endoscopic retrograde cholangiopancreatography examinations fulfilled the inclusion criteria. Patients with an intact papilla who required biliary cannulation were screened. The cohort was divided into a nonprecut group (n=481) and a precut group (n=121). The standard technique included free biliary cannulation with a tapered-tip cannula. An Erlangen type papillotome was used for precutting. Complications, success rate of cannulation, and hyperamylasemia were recorded.

Results Complication rates were similar in the 2 groups (nonprecut 7.1% vs. precut 8.3%, P=0.7). Hyperamylasemia was more common in the precut group (13.3% vs. 31.3%, P<0.001). The final deep biliary cannulation rate after precut papillotomy in cases with problematic cannulation was 98.2%.

Conclusions Erlangen precut papillotomy results in a high deep biliary cannulation rate with no increased risk of complications when compared to cannulation using standard techniques.

Department of Gastrointestinal Surgery, Oulu University Hospital, Finland

Reprints: Dr Jukka Palm, MD, Department of Surgery, Oulu University Hospital, P.O. Box 22, 90029 OYS, Finland (e-mail:

Received for publication January 6, 2006; accepted November 10, 2006

Sources of support: none.

© 2007 Lippincott Williams & Wilkins, Inc.