{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:15:17Z","timestamp":1790709317421,"version":"4.1.0"},"reference-count":36,"publisher":"The Korean Society of Gastrointestinal Endoscopy","issue":"1","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"content-domain":{"domain":["e-ce.org"],"crossmark-restriction":true},"short-container-title":["Clin Endosc"],"published-print":{"date-parts":[[2026,1,30]]},"abstract":"<jats:p>Background\/Aims: Biliary cannulation is a critical component of endoscopic retrograde cholangiopancreatography (ERCP). When standard methods fail, needle-knife precut sphincterotomy (NKPS) is commonly employed. This systematic review and meta-analysis evaluated the safety and efficacy of using NKPS as a primary technique.Methods: Electronic databases were searched for studies published between January 2000 and November 2024 that assessed outcomes of primary precut techniques. \u201cPrimary precut\u201d was defined as needle-knife sphincterotomy performed as the initial approach without any prior standard cannulation attempts. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the Q-test and the I\u00b2 statistic.Results: The mean patient age was 57.95 years (standard deviation [SD], 7.59), and 53.23% were female. The cannulation success rate was 96.50% (95% confidence interval [CI], 94.90\u201397.60) with no heterogeneity (Q, 7.10; df, 8; I\u00b2=0%; p=0.935). The rates of adverse events were as follows: post-ERCP pancreatitis, 1.90% (95% CI, 1.20\u20133.10; I\u00b2=0; p =0.942); bleeding, 2.60% (95% CI, 1.70\u20134.00, I\u00b2=0; p=0.725); cholangitis, 1.50% (95% CI, 0.60\u20133.60; I\u00b2=45.27; p=0.067); and perforation, 0.90% (95% CI, 0.40\u20131.90; I\u00b2=0; p=0.948). The overall adverse event rate was 9.70% (95% CI, 5.70\u201316.10; I\u00b2=83.39; p&lt;0.001).Conclusions: Primary precut sphincterotomy appears to be an effective and safe technique for biliary cannulation in ERCP. These findings support its consideration as a viable first-line approach in appropriate clinical settings.<\/jats:p>","DOI":"10.5946\/ce.2025.110","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T08:01:19Z","timestamp":1760083279000},"page":"58-66","update-policy":"https:\/\/doi.org\/10.5946\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Safety and efficacy of primary precut techniques for biliary cannulation: a systematic review and meta-analysis"],"prefix":"10.5946","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8602-3980","authenticated-orcid":true,"given":"Eugene","family":"Annor","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4229-0455","authenticated-orcid":true,"given":"Nneoma","family":"Ubah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3166-9594","authenticated-orcid":true,"given":"Dhaval","family":"Save","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9715-8829","authenticated-orcid":true,"given":"Ishaan","family":"Vohra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8889-869X","authenticated-orcid":true,"given":"Ritu Raj","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-9039","authenticated-orcid":true,"given":"Dushyant Singh","family":"Dahiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8936-1870","authenticated-orcid":true,"given":"Bhanu Siva Mohan","family":"Pinnam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4921-8794","authenticated-orcid":true,"given":"Harishankar","family":"Gopakumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3961","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2021.09.010"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.33590\/emjhepatol\/21-00005"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v8.i14.2988"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1055\/s-0042-108641"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-020-01455-0"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.08.005"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-012-2271-8"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-024-08603-6"},{"key":"ref9","first-page":"16","volume-title":"Needle-knife fistulotomy versus standard method for cannulation of common bile duct: a randomized controlled trial","author":"Khatibian","year":"2008"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.04.011"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v24.i16.1803"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000480"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-96142-9"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.12998\/wjcc.v9.i17.4166"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000788"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/6662000"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2020.06.064"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.igie.2023.01.004"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-09117-9"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-021-06983-7"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2005.05.022"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s00534-012-0552-4"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2008.09.037"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.09.015"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1005476"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.06.051"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-2980.2010.00454.x"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012213"},{"key":"ref29","first-page":"291","volume-title":"Precut sphincterotomy for selective biliary duct cannulation during endoscopic retrograde cholangiopancreatography","author":"Davee","year":"2012"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2016.09.037"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-944962"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.345"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-42614"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9270(00)02387-x"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-023-10058-1"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13226940"}],"container-title":["Clinical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-ce.org\/upload\/pdf\/ce-2025-110.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-ce.org\/journal\/view.php?doi=10.5946\/ce.2025.110","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-ce.org\/upload\/pdf\/ce-2025-110.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T07:02:33Z","timestamp":1769583753000},"score":1,"resource":{"primary":{"URL":"http:\/\/e-ce.org\/journal\/view.php?doi=10.5946\/ce.2025.110"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,30]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"URL":"https:\/\/doi.org\/10.5946\/ce.2025.110","relation":{},"ISSN":["2234-2400","2234-2443"],"issn-type":[{"value":"2234-2400","type":"print"},{"value":"2234-2443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,30]]},"assertion":[{"value":"2025-04-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-10","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-30","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}