Primary Precut vs. Early Precut Sphincterotomy During ERCP

Few issues are more controversial in the world of endoscopic retrograde cholangiopancreatography (ERCP) than when to perform precut sphincterotomy. The term refers to a variety of endoscopic techniques whereby a biliary sphincterotomy is performed without preexisting guidewire access to the biliary tree. Most practitioners view precut sphincterotomy as a relatively high-risk maneuver and turn to it only after protracted attempts at cannulation using standard methods have failed.

Now, investigators have conducted a randomized, controlled trial to assess the safety and efficacy of precut sphincterotomy in 303 patients at a tertiary-care hospital in India. The most common indications were choledocholithiasis (57% of patients) and biliary strict…