Aims The aim of our study is to analyze the utility and complications associated with
this technique.
Methods We conducted a retrospective study on patients admitted for ERCP between 2009 and
December 2023. A comparison was made between the indications and outcomes of patients
who underwent pre-cut sphincterotomy and those who received standard cannulation techniques
Results A total of 4,092 ERCPs were performed. Pre-cut sphincterotomy (infundibulotomy) was
used in 282 patients (7%), with a mean age of 63.2 years and a male-to-female ratio
of 1.88.The indications for ERCP in this group were as follows: malignant tumor pathology
in 48% of cases and benign pathology in the remaining patients. Pre-cut sphincterotomy
enabled access to the bile duct after failure of standard techniques in 93% of patients.
Failure of the pre-cut technique occurred in 20 patients (7%), among whom 14 patients
underwent a repeat ERCP, allowing access to the bile duct after either enlarging the
pre-cut in 8 cases or spontaneously in 3 cases. Follow-up of patients during and after
the procedure revealed the following complications: acute pancreatitis in 10 patients
(3%), 12 cases of bleeding during the procedure controlled with balloon tamponade,
and 1 case requiring radiological embolization. Three cases of perforation were observed
following pre-cut enlargement. In the standard cannulation group, the most common
indication for ERCP was bile duct stones in 76% of cases. Complications included pancreatitis
in 24 cases, bleeding after large sphincterotomy in 17 cases, perforation in 4 cases,
and a subcapsular liver hematoma in 1 case.
Conclusions The results of this study demonstrate the effectiveness of pre-cut sphincterotomy
as a useful technique in difficult bile duct cannulation cases. The comparison of
complications between the two groups did not reveal any significant differences. The
causal relationship between the use of this technique and the occurrence of complications
was not established in our study
