Pure cut electrocautery current for sphincterotomy causes less post-procedure pancreatitis than blended current☆,☆☆,★
Section snippets
Methods
All patients undergoing biliary endoscopic sphincterotomy between November 1994 and June 1995 were randomized to either blended or pure cut current. Patients having sphincterotomy performed on even calendar dates received blended current, whereas patients undergoing sphincterotomy on odd calendar dates received pure cutting current. Five attending gastroenterologists either performed or closely supervised gastroenterology fellows in the performance of the procedures. This study was approved by
Results
One hundred seventy consecutive patients undergoing biliary sphincterotomy were entered into the trial. There were 56 women and 30 men in the pure cut group and 54 women and 30 men in the blended current group. The age range was 19 to 96 years (mean 51 years) in the blended current group and 21 to 92 years (mean 55 years) in the pure cut group. The study was stopped after interim analysis showed a lower pancreatitis rate in the pure cut group. The indications for sphincterotomy are listed in
Discussion
Since the introduction of endoscopic sphincterotomy over 20 years ago, the indications and use of this procedure have grown steadily. It is now generally recognized as the preferred method of treatment for many biliary disorders, including choledocholithiasis, papillary stenosis, and cholangitis. 4, 5 The complications of endoscopic sphincterotomy are similar to those for diagnostic ERCP but occur more frequently. A large prospective multicenter trial of 2347 patients undergoing biliary
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Cited by (108)
Endotherapy for Pancreas Divisum
2023, Gastrointestinal Endoscopy Clinics of North AmericaAdverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials
2020, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :The initial bleeding analysis involved 3 studies [14,30,31] with 540 patients, which showed fewer adverse events with blend mode (RD: 0.18 [0.11, 0.24], P < 0.00001, I2 = 98%). The funnel plot revealed an outlier [14], which was excluded, allowing an analysis with low heterogeneity (I2 = 0%). Thus, the analysis of the remainder two articles[30,31] (370 patients) was favorable to the blend modality (RD: 0.26 [0.61, 0.35], P < 0.00001, I2 = 0%).
Electrosurgery in Therapeutic Endoscopy
2019, Clinical Gastrointestinal EndoscopyDifficult Cannulation and Sphincterotomy
2019, Clinical Gastrointestinal EndoscopyPancreatic Sphincterotomy
2018, ERCP, Third EditionBiliary Sphincterotomy
2018, ERCP, Third Edition
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From the Division of Gastroenterology, Department of Internal Medicine, University of Michigan at Ann Arbor
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Reprint request: Grace H. Elta, MD, 3912 Taubman Center, University of Michigan, Ann Arbor, MI 48109-0362.
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