Can early precut reduce post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with difficult bile duct cannulation?

Table 1 Baseline characteristics and comparison of post-endoscopic retrograde cholangiopancreatography pancreatitis incidence between needle-knife precut papillotomy cases and non-needle-knife precut papillotomy cases

Characteristic	NKPP, n = 294	Non-NKPP, n = 1262	P value
Age	75.5 ± 13.0	73.6 ± 13.4	0.016
Sex, male	159 (53.7)	690 (54.6)	0.80
Diagnosis			< 0.01
Benign	205 (69.3)	980 (77.6)
Malignancy	91 (30.7)	283 (22.4)
Diverticula	77 (26.0)	380 (30.1)	0.18
First endoscopist			0.050
Trainee, n = 903	156 (53.0)	747 (59.2)
Success rate of cannulation	283 (96.3)	1250 (99.0)	< 0.01
Cannulation time in min	20.3 ± 12.6	5.1 ± 7.2	< 0.01
Total procedure time in min	40.4 ± 16.0	29.7 ± 17.9	< 0.01
PEP	21 (7.1)	68 (5.4)	0.27

Data are n (%). NKPP: Needle-knife precut papillotomy; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Table 2 Baseline characteristics and result of the incident rate of post-endoscopic retrograde cholangiopancreatography pancreatitis between early needle-knife precut papillotomy group and delayed needle-knife precut papillotomy group

Characteristic	EP group, n = 142	DP group, n = 152	P value
Age	74.8 ± 13.6	76.3 ± 12.4	0.39
Sex, male	81 (57)	77 (50.7)	0.29
Diagnosis
Benign	101 (71.1)	103 (67.8)	0.61
Malignancy	41 (28.9)	49 (32.2)
Diverticula	30 (21.1)	47 (37.6)	0.064
First endoscopist			< 0.01
Trainee, n = 154	43 (30.3)	111 (73.0)
Trainer, n = 141	99 (69.7)	41 (27.0)
NKPP start time in min	5.7 ± 3.1	17.1 ± 5.6	< 0.01
Success rate of cannulation	140 (98.6)	143 (94.1)	0.027
Cannulation time in min	13.2 ± 8.6	27.3 ± 12.0	< 0.01
Total procedure time in min	35.0 ± 15.7	45.8 ± 14.4	< 0.01
PEP	5 (3.5)	16 (10.5)	0.023

Data are n (%). DP: Delayed needle-knife precut papillotomy; EP: Early needle-knife precut papillotomy; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.

Table 3 Analysis of efficacy of endoscopic pancreatic stenting for post-endoscopic retrograde cholangiopancreatography pancreatitis prevention

Complication	EP group, n = 142		DP group, n = 152		P value
	Without EPS, n = 79	With EPS, n = 63	Without EPS, n = 75	With EPS, n = 77
PEP	3 (3.8)	2 (3.2)	13 (17.3)	3 (3.9)	< 0.01a

^aP < 0.01 without EPS in the DP group vs with EPS in the DP group.

Data are n (%). DP: Delayed needle-knife precut papillotomy; EP: Early needle-knife precut papillotomy; EPS: Endoscopic pancreatic stenting; PEP: Post-endoscopic retrograde cholangiopancreatography pancreatitis.