Application of Precut Papillotomy in Patients With Surgically Altered Gastrointestinal Anatomy

It is challenging to perform ERCP (endoscopic retrograde cholangiopancreatography) in patients with surgically altered gastrointestinal anatomy. The failure rate of selective bile duct cannulation by the standard method is high. To explore the application of precut papillotomy (PP) technique in patients with gastrectomy, we carried out this retrospective analysis. From January 2017 to September 2020, 107 patients with surgically altered gastrointestinal anatomy were referred to our department for ERCP examination. Among them, 11 cases were duodenal stricture or jejunal stricture, resulting in the inability to reach the duodenal papilla. Eleven patients stopped cannulation because they could not tolerate the further operation. 60 patients were intubated successfully by standard method. Finally, 25 patients using the precut papillotomy technique were included in our analysis. Of the 25 patients who used pp, 21 completed selective biliary cannulation, with a success rate of 84% (21/25). Compared with standard intubation, the PP technique increased the success rate of intubation in patients with altered anatomy by 21.9%. Among the patients we included, 2 cases had adverse events, including 1 case of acute pancreatitis and 1 case of perforation; the incidence of adverse events was 8%. All adverse events were mild and cured after conservative treatment. In patients with gastrointestinal anatomical changes, PP is effective and relatively safe to improve the selective biliary cannulation success rate.