Please use this identifier to cite or link to this item: http://hdl.handle.net/1822/29559

TitleEarly precut fistulotomy for biliary access: time to change the paradigm of "the later, the better?"
Author(s)Lopes, Luís
Ribeiro, Mário Dinis
Rolanda, Carla
Issue date2014
PublisherElsevier
JournalGastrointestinal Endoscopy
CitationLopes, L., Dinis-Ribeiro, M., & Rolanda, C. (2014). Early precut fistulotomy for biliary access: Time to change the paradigm of "the later, the better"? Gastrointestinal Endoscopy, 80(4), 634-641. doi: 10.1016/j.gie.2014.03.014
Abstract(s)The precut timing during the biliary cannulation algorithm is a subject of controversy. Some studies suggest that early institution of precut is a safe and effective strategy even though the extent to which this approach may affect the duration of the ERCP is seldom addressed. OBJECTIVE: To assess the success, safety, and procedure duration of an early precut fistulotomy (group A) versus a classic precut strategy after a difficult biliary cannulation (group B). DESIGN: Single-center, prospective cohort study. SETTING: University-affiliated hospital. PATIENTS: A total of 350 patients with a naïve papilla. INTERVENTIONS: Standard biliary cannulation followed by needle-knife fistulotomy (NKF). MAIN OUTCOME MEASUREMENTS: Biliary cannulation rate, NKF success, adverse events, and ERCP duration. RESULTS: The overall cannulation rate was similar, at 96% and 94% for groups A and B, respectively. The adverse event rate was 6.2% and 6.4%, respectively, with pancreatitis as the most frequent adverse event (group A, 3.9%; group B, 5.2%). The mean ERCP duration was, however, significantly shorter in group A, both when biliary cannulation was achieved without precutting (14 minutes vs 25 minutes, P < .001) as well as when biliary cannulation was attempted after NKF (18 minutes vs 31 minutes, P < .0001). LIMITATIONS: Single-center study design, referral center. CONCLUSIONS: If the endoscopist is experienced in ERCP and precut techniques, an early precut strategy should be the preferred cannulation strategy because this approach is as safe and effective as the late fistulotomy approach and substantially reduces ERCP duration.
TypeArticle
URIhttp://hdl.handle.net/1822/29559
DOI10.1016/j.gie.2014.03.014
ISSN0016-5107
Publisher versionhttp://www.sciencedirect.com/science/article/pii/S0016510714012395
Peer-Reviewedyes
AccessOpen access
Appears in Collections:ICVS - Artigos em Revistas Internacionais com Referee

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