{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T19:33:55Z","timestamp":1757619235696,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2020,2,17]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                  <jats:title>Goals<\/jats:title>\n                  <jats:p>Our study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Complication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study<\/jats:title>\n                  <jats:p>We performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I\u2013IV ERCP difficulty\/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively\u2014a statistically significant difference (p&lt;0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2019-101380","type":"journal-article","created":{"date-parts":[[2020,3,2]],"date-time":"2020-03-02T17:19:47Z","timestamp":1583169587000},"page":"113-117","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of precut sphincterotomy techniques in cases of difficult biliary access"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1070-4621","authenticated-orcid":false,"given":"Jared","family":"Rejeski","sequence":"first","affiliation":[{"name":"Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Hines","sequence":"additional","affiliation":[{"name":"Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0054-5986","authenticated-orcid":false,"given":"Jason","family":"Jones","sequence":"additional","affiliation":[{"name":"Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Conway","sequence":"additional","affiliation":[{"name":"Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girish","family":"Mishra","sequence":"additional","affiliation":[{"name":"Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Evans","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, Ochsner Medical Center, New Orleans, Louisiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishi","family":"Pawa","sequence":"additional","affiliation":[{"name":"Section on Gastroenterology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,2]]},"reference":[{"key":"2025090709400976000_12.2.113.1","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1038\/ajg.2013.217","article-title":"Intraprocedural quality in endoscopic retrograde cholangiopancreatography: a meta-analysis","volume":"108","author":"DeBenedet","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"2025090709400976000_12.2.113.2","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.gie.2016.06.051","article-title":"Adverse events associated with ERCP","volume":"85","author":"Chandrasekhara","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"2025090709400976000_12.2.113.3","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1055\/s-0028-1098295","article-title":"Endoscopic retrograde cholangiography (ERC) through artificial endoscopic choledocho-duodenal fistula","volume":"10","author":"Caletti","year":"1978","journal-title":"Endoscopy"},{"key":"2025090709400976000_12.2.113.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(05)80011-2"},{"key":"2025090709400976000_12.2.113.5","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1055\/s-2002-35834","article-title":"Complications of endoscopic sphincterotomy: results from a single tertiary referral center","volume":"34","author":"Barthet","year":"2002","journal-title":"Endoscopy"},{"key":"2025090709400976000_12.2.113.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2007.01279.x"},{"key":"2025090709400976000_12.2.113.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)02169-8"},{"key":"2025090709400976000_12.2.113.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(02)70112-0"},{"key":"2025090709400976000_12.2.113.9","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.cgh.2012.12.017","article-title":"Needle knife sphincterotomy does not increase the risk of pancreatitis in patients with difficult biliary cannulation","volume":"11","author":"Swan","year":"2013","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025090709400976000_12.2.113.10","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/SLE.0000000000000062","article-title":"Guidewire-assisted transpancreatic sphincterotomy for difficult biliary cannulation: a prospective randomized controlled trial","volume":"24","author":"Zang","year":"2014","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2025090709400976000_12.2.113.11","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1016\/j.cgh.2015.06.035","article-title":"Early precut sphincterotomy does not increase risk during endoscopic retrograde cholangiopancreatography in patients with difficult biliary access: a meta-analysis of randomized controlled trials","volume":"13","author":"Sundaralingam","year":"2015","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025090709400976000_12.2.113.12","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1055\/s-0043-111717","article-title":"Transpancreatic sphincterotomy has a higher cannulation success rate than needle-knife precut papillotomy\u2014a meta-analysis","volume":"49","author":"P\u00e9csi","year":"2017","journal-title":"Endoscopy"},{"key":"2025090709400976000_12.2.113.13","doi-asserted-by":"crossref","first-page":"3978","DOI":"10.3748\/wjg.v21.i13.3978","article-title":"Endoscopic transpancreatic septotomy as a precutting technique for difficult bile duct cannulation","volume":"21","author":"Miao","year":"2015","journal-title":"World J Gastroenterol"},{"key":"2025090709400976000_12.2.113.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-008-0056-0"},{"key":"2025090709400976000_12.2.113.15","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/SLE.0000000000000062","article-title":"Guidewire-assisted transpancreatic sphincterotomy for difficult biliary cannulation: a prospective randomized controlled trial","volume":"24","author":"Zang","year":"2014","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"2025090709400976000_12.2.113.16","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/S0016-5107(04)01877-2","article-title":"Endoscopic transpancreatic papillary septotomy for inaccessible obstructed bile ducts: comparison with standard pre-cut papillotomy","volume":"60","author":"Catalano","year":"2004","journal-title":"Gastrointest Endosc"}],"container-title":["Frontline Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/flgastro-2019-101380","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T16:40:17Z","timestamp":1757263217000},"score":1,"resource":{"primary":{"URL":"https:\/\/fg.bmj.com\/lookup\/doi\/10.1136\/flgastro-2019-101380"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,2]]},"references-count":16,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,5]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/flgastro-2019-101380"],"URL":"https:\/\/doi.org\/10.1136\/flgastro-2019-101380","relation":{},"ISSN":["2041-4137","2041-4145"],"issn-type":[{"type":"print","value":"2041-4137"},{"type":"electronic","value":"2041-4145"}],"subject":[],"published":{"date-parts":[[2020,3,2]]}}}