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Conventional techniques for biliary cannulation are unsuccessful in 5% to 10% of patients. Although precut needle-knife sphincterotomy (NKS) can improve the cannulation success rate, this technique has been associated with increased morbidity, particularly postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Investigators examined the relationship between NKS and ERCP complications using data that were collected prospectively from two successive randomized ERCP trials involving 732 patients. PEP was the primary endpoint in both trials, and all patients had intact papilla. Most procedures were begun by a fellow; if biliary cannulation failed after 5 minutes, an expert biliary endoscopist took over. NKS was performed …