Role of pre cut sphincterotomy in difficult biliary cannulation

ABSTRACT

To assess the success rate and complications of pre cut sphincterotomy [PBS] in achieving deep common bile duct [CBD] cannulation where standard techniques of biliary cannulation failed. Descriptive study Surgical Unit 4, Civil Hospital Karachi from 14 October, 2006 to 18th December, 2007. Thirty five patients, in whom needle knife was done due to difficulty in achieving cannulation by standard means, in a 14 months period were included in the study .The data was entered into the ERCP database, locally developed at the time of ERCP and follow up was done at 24 hours and 15 days. Data was collected prospectively. No randomization was done. The main outcome measures were success and complications of precut sphincterotomy. Success of the PS was defined as the ability to deeply cannulate the CBD. Statistical data was extracted from the SPSS version 11. Variables were compared using Chi-square or t-tests as appropriate. A total of 327 ERCP's were performed during the study period out of which 35 [10.70%] precut sphincterotomies were done. The average age in the PBS group was 44.83 years [range 26- 80 years], and 71.4% [n=25] were females. Biliary cannulation was successful in 60% of the patients in the first attempt and 66.66% at a subsequent attempt. The cumulative success rate was 92.5%. Complication rate was 25.9%. Of seven PBS related complications pancreatitis occurred in four [11.4%], infection in two [5.7%] and bleeding in one patient [2.9%]. Difficulty in PBS should be anticipated in post surgical patients with altered anatomy and collapsed biliary system like CBD leakage and long distal strictures. Complication rate increases with subsequent attempts at cannulation. Overall, in experienced hands, PBS is safe and effective procedure in achieving selective cannulation