Early precut is useful for difficult bile duct cannulation, particularly in cases with long oral protrusion.

Abstract

Background: Endoscopic retrograde cholangiopancreatography involves selective bile duct cannulation, which is often challenging and associated with complications. In difficult cannulation cases, early precutting is frequently used. However, its efficacy and optimal indications require further evaluation.

Aim: To evaluate the efficacy and safety of early precut (EP) in difficult bile duct cannulation.

Methods: This retrospective analysis of endoscopic retrograde cholangiopancreatography procedures was performed for bile duct cannulation in patients with naive papillae who required advanced cannulation techniques (ACTs). These patients were admitted between April 2020 and March 2024 and were analyzed for risk factors, success rates, and complications. Outcomes were compared between the EP group and the conventional other ACTs group, with a focus on cases with oral protrusion large (oral protrusion-L).

Results: The need for ACTs was identified as an independent risk factor for complications [odds ratio (OR) = 5.4; 95% confidence interval: 1.887-15.53]. Malignant biliary strictures (OR = 2.58) and oral protrusion-L (OR = 2.77) were also identified as independent risk factors for requiring ACTs. The EP group had a significantly higher second-line cannulation success rate (97.9% vs 73.2%, P = 0.001) and lower complication rate (8.3% vs 39.0%, P = 0.001) than the other ACTs group. Additionally, similar benefits were observed in the oral protrusion-L cases.

Conclusion: This study provides compelling evidence that EP is a viable alternative and a superior strategy in cases requiring ACTs, particularly oral protrusion-L.