Zagazig University, Zagazig Egypt.
Title: PRECUT PAPILLOTOMY FOR BILIARY CANNULATION IN CIRRHOTIC PATIENTS. IS THERE A DIFFERENCE BETWEEN EARLY AND LATE PRECUT?
PhD in Internal Medicine.
Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Background: The use of precut papillotomy (PP) either early (EPP) or late (LPP) was not yet established in patients with liver cirrhosis. Objective: The aim of this study was to assess the efficacy and safety of PP in cirrhotic patients and to compare the results of EPP vs. LPP. Methods: We assigned 135 cirrhotic, who needs management of biliary obstruction, into three equal groups, with either, EPP adopted after < five unsuccessful biliary cannulation attempts, LPP performed after ≥ five unsuccessful attempts, or no precut (NOPP) using standard cannulation (SC) only. Technical success, morbidity and mortality were compared among groups. Results: Cannulation success rate did not differ significantly between EPP (95.56%) and LPP cases (91.11%), but was significantly lower in NOPP cases (73.33%). Overall post-procedure complication rate was 11.11%, including pancreatitis (5,19%), bleeding (5,19%) and perforation (0.74%). Hepatic encephalopathy developed in four patients with two mortalities (1.48%). Apart from a significantly lower pancreatitis rate in EPP group than LPP group (p=0.041), there were no significant differences among groups regarding complications or mortality.
Conclusion: In cirrhotic patients, EPP is as safe and effective as LPP, with a lower pancreatitis risk. Both precut techniques have superior efficacy and similar safety to SC.
Keywords: precut papillotomy, biliary cannulation, liver cirrhosis.