Does precut technique improve selective bile duct cannulation or increase post-ERCP pancreatitis rate? A meta-analysis of randomized controlled trials

There is no clear answer regarding use of precut technique versus conventional method in achieving successful biliary cannulation. To compare the effectiveness of precut technique with that of conventional biliary cannulation by meta-analysis of available randomized controlled trials (RCTs). Databases including MEDLINE, EMBASE, Cochrane Library, and Science Citation Index updated to July 2009 were searched. Main outcome measures were success rates of biliary cannulation, incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications, and post-ERCP pancreatitis rate. Meta-analysis of these clinical trials was performed. Six RCTs were included. The primary biliary cannulation rate reported with precut and conventional techniques was 89.3 and 78.1%, respectively. Pooled analysis of all selected studies comparing precut cannulation technique with conventional techniques yielded an odds ratio (OR) of 2.05 [95% confidence interval (CI): 0.64-6.63]. Pooled analysis comparing post-ERCP pancreatitis rates for the precut-cannulation groups with those for the conventional-method groups yielded an rate ratio (RR) of 0.46 (95% CI: 0.23-0.92). This meta-analysis shows that the precut technique does not increase the primary cannulation rate. However, the technique reduces the risk of post-ERCP pancreatitis compared with conventional technique. Further large, well-performed, randomized controlled studies are needed to confirm these findings.