Outcome of precut sphincterotomy compared to standard cannulation techniques in ERCP with difficult cannulation

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a key procedure in managing biliary and pancreatic disorders. In cases of difficult cannulation (DC), when standard cannulation techniques (SCT) fail, precut sphincterotomy (PS) may be used as an alternative technique, often by experienced endoscopists. The aim of this study was to compare outcomes of PS versus SCT in cases of DC, regarding complication rates and successful cannulation. Method Data were retrieved from the Swedish GallRiks Registry from September 2016 to December 2023. A total of 30,561 ERCPs, performed as index ERCPs without rendezvous technique, were identified and cross-checked. Univariable and multivariable logistic regression were conducted. We used generalized estimating equations to adjust for endoscopist- and hospital volumes. Result Altogether 9,909 procedures were classified as DC among which 3,005 (30%) were performed with PS, compared to 434 (2%) of 20,218 in the non-DC group. In DC PS was not associated with increased risk of procedure related complications (pancreatitis, cholangitis, bleeding, bile leakage or perforation). The rate of successful cannulation in DC was 87.9% when SCT were used and 70.4% when PS was performed. Discussion PS is a safe technique in ERCP when cannulation is difficult and is not associated with an increased risk of complications compared to SCT.