الفهرس 
• Anatomy of the biliary systemOnly 14 pages are availabe for public view
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Abstract
Pre-cut technique is useful in allowing biliary access when standard methods of biliary cannulation have failed.
There are several techniques to perform pre-cut papillotomy. The most widely practiced is the precut using the freehand needle knife. While, pre-cutting can be also achieved using the pull-type sphincterotome.
The aim of this study is to compare safety and efficacy of pull sphincterotome and NKS as precut methods for bile duct access after failed cannulation.
In order to fulfill this aim, a prospective study was conducted at the ERCP unit in Ain Shams University Hospitals in the period from January 2008 till April 2009. A total number of 368 patients were enrolled in the study from which 140 cases fulfilled the inclusion criteria. The included cases were randomly subdivided according to the precut technique used into group A which included 70 patients with precut using the standard pull sphincterotome and group B which included 70 patients with precut using the needle Knife.
All the patients were evaluated using an evaluation sheet included the time of the procedure, success rate of cannulation, success rate of drainage of CBD, the rate of complication after each procedure which included pancreatitis, perforation, bleeding, cholangitis, contast nephropathy and mortality as potential post-ERCP complications.
The results showed that precut using the pull type sphincterotome had a higher success rate of CBD cannulation and in more rapid time than needle knife. Meanwhile, there was no statistically significant difference between both groups as regards fair drainage of the biliary tree.
Regarding the complications, the pull sphincterotome showed a higher incidence of pancreatitis than the needle knife while, the needle knife showed a higher incidence of procedure bleeding.
There was no statistically significant difference between both groups regarding other complications as perforation, cholangitis, contrast nephropathy, prolonged hospital stay or mortality.
In order to reveal the predictors and risk factors of failure of precut technique 12 variables were studied. The risk factors in bivariate analysis for failure of technique were: patients with age above 50 years, no use of extraction ballon, failure of complete drainage of biliary tree and high level of base line bilirubin before procedure.
In the multivariate analysis the predictors of failure were: no use of extraction ballon, precut without CBD stent insersion, incomplete drainage of the biliary tree, amount of injected dye exceeds 50 cc and use of endoscpic sphincterotomy.