Biliary sphincterotomy and precut

Abstract

The role of endoscopic retrograde cholangiopancreatography (ERCP) has changed through the years with an increasingly therapeutic purpose in patients with biliary disease. In this context, endoscopic sphincterotomy (EST) is a fundamental procedure. There are several available accessories to perform EST that must be known by endoscopists, as well as the technique and possible complications of the procedure. The most important step in ERCP is to achieve a common bile duct cannulation, which remains a challenge even for the most experienced endoscopists, with a failure rate of up to 10%. In these cases, an alternative technique is needed. Siegel first described the precut sphincterotomy with the use of needle-knife sphincterotome in 1980, and since that date the technique has evolved a lot and many variations and accessories have been introduced. However, precut techniques remain a complex procedure with high risk of complications even for the most experienced endoscopists. The purpose of this chapter is to focus on EST and precut techniques, equipment, outcomes, adverse events, as well as indications and contraindications.