Comparison of the need for precutting to achieve biliary cannulation in patients with choledocholithiasis versus patients with pancreatic head cancer

Aims Needle-knife fistulotomy to achieve biliary cannulation is frequently used as the preferred precutting technique when standard cannulation techniques fail according to ESGE recommendations [1] [2]. The aim of this study is to investigate whether the underlying disease – pancreatic head cancer versus choledocholithiasis – affects the need for precutting.

Methods We retrospectively studied the data of 150 patients who underwent ERCP for choledocholithiasis and 150 patients who underwent ERCP for pancreatic cancer. In the latter group we included patients with locally advanced pancreatic head cancer and no endoscopic features of mucosal infiltration of the papilla or duodenum. All the procedures were carried out by the same endoscopist, at the same hospital.

Results Needle-knife fistulotomy was performed in 19 patients in the CBD stone group and in 51 patients in the cancer group. Biliary cannulation was achieved in all patients except for two in the cancer group despite precutting. Patients with choledocholithiasis were significantly less likely to require precut during ERCP compared to those with pancreatic head cancer (adjusted OR: 0.28, 95% CI: 0.16-0.51, p<0.001) adjusted for age and gender. This indicates that the odds of needing precut in choledocholithiasis patients are approximately 72% lower than in pancreatic cancer patients. The strong association between pancreatic head cancer and need for precutting can be attributed to the anatomical changes and technical challenges posed by locally advanced tumors.

Conclusions The two most common indications for ERCP are complications of choledocholithiasis and pancreatic head cancer. Patients with the latter disease have significantly higher probability for precutting to achieve biliary cannulation. This is important to bear in mind when planning ERCP in patients with cancer as it may affect time of procedure and risk of complications. Such cases have higher success rates in the hands of experienced endoscopists.

Publication History

Article published online:
27 March 2025

• References

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