Feasibility of primary precut sphincterotomy in endoscopic retrograde cholangiopancreatography for patients with large oral protrusions of the duodenal papilla; prospective observation study in Japan

Background/Aims: Large oral protrusions may increase the difficulty of biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) and often require precut sphincterotomy. Precut sphincterotomy is a risk factor for post-ERCP pancreatitis (PEP). However, this may be reduced by a primary precut sphincterotomy. This study aimed to evaluate the results of biliary cannulation after primary precut sphincterotomy in patients with large oral protrusions identified during ERCP.Methods: In this prospective observation study, we included 38 patients with naïve papillae who underwent ERCPs between January 2021 and December 2022 that revealed large oral protrusions and who underwent primary precut sphincterotomies as the biliary cannulation method. Primary precut sphincterotomy was performed by an experienced endoscopist in all cases.Results: The biliary cannulation success rate for primary precut sphincterotomies was 100% (38/38 patients). There were seven cases (18.4%) of ERCP-related adverse events, specifically bleeding. Of these, six (15.8%) were mild and one (2.6%) was moderate. No cases of PEP were observed.Conclusions: Primary precut sphincterotomy for large oral protrusions performed by an experienced endoscopist had a high biliary cannulation success rate without the occurrence of PEP. This procedure can be used for biliary cannulation in patients with large oral protrusions (University Hospital Medical Information Network-Clinical Trials Registry number: UMIN000042805).