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    The Significance of Sphincterotomy Techniques in the Complications of Endoscopic Retrograde Cholangiopancreatography
    (2019) Akın, Mete; Adanır, Haydar; Uçmak, Feyzullah; Tuna, Yaşar
    Objective: Endoscopic retrograde cholangiopancreatography (ERCP) has been used primarily fortherapeutic interventions. Precut sphincterotomy is a technique that is used after conventional methodsof biliary cannulation have failed. We aimed to evaluate whether the precut technique increases thefrequency of complications.Material and Methods: Two hundred fifteen patients in whom ERCP was performed wereprospectively evaluated. One hundred eighty-five patients included in the study were divided intothree groups based on the cannulation technique: Group 1: Deep biliary cannulation or cannulationby guide wire; Group 2: Precut technique; Group 3: If cannulation was not possible with these twotechniques within 10 minutes, a precut with needle-knife sphincterotomy was carried out in thesepatients. Complete blood count, and blood serum amylase and lipase levels were checked before andafter the procedure. The patients were monitored for 30 days for the development of any complications.Results: Complications were observed in 26 (14%) of 185 patients, including pancreatitis in 18(9.7%) patients, cholangitis in six (3.2%) patients, and hemorrhage in two (1.1%) patients. Thefrequency of complications was 9.2% in group 1, 9.3% in group 2, and 35.3% in group 3 (p<0.05).When multivariate analysis was applied, the difficulty of cannulation and opaque injection into thepancreatic duct were correlated with elevated complication rates.Conclusion: Difficult cannulation and opaque injection into the pancreas are risk factors forcomplications after ERCP, while the precut technique is safe. Therefore, it is recommended toprefer the precut method earlier instead of insisting on conventional techniques, to avoid the risk ofcomplications.