Article Text

Download PDFPDF
Original research
Outcomes of precut sphincterotomy techniques in cases of difficult biliary access
  1. Jared Rejeski1,
  2. Marc Hines1,
  3. Jason Jones1,
  4. Jason Conway1,
  5. Girish Mishra1,
  6. John Evans2,
  7. Rishi Pawa1
  1. 1 Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
  2. 2 Section of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana, USA
  1. Correspondence to Dr Jared Rejeski, Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA; jarejesk{at}


Goals Our study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.

Background Complication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.

Study We performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.

Results We identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p<0.001).

Conclusion This data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.

  • precut sphincterotomy
  • difficult biliary access
  • post-ERCP pancreatitis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Each author contributed to the manuscript. JR planned, recorded, drafted/edited and submitted the manuscript; MH recorded necessary data; JJ recorded necessary data; JC edited the manuscript; GM edited the manuscript; JE edited the manuscript; and RP planned, ensured the conduct of, and edited the manuscript. RP is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GM has received consultant fees from Pentax Medical Company and Cook Medical. There are no other conflicts of interest to disclose. There are no sources of funding for this manuscript.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.