Copyright
©The Author(s) 2025.
World J Gastrointest Endosc. Sep 16, 2025; 17(9): 108420
Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.108420
Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.108420
Table 1 Baseline characteristics of all patients, n (%)
| Characteristic | n = 403 |
| Age median (range) | 78 (29-104) |
| Gender (male/female) | 230/173 |
| Primary disease | |
| Benign disease | 266 (66) |
| Bile duct stones | 240 (59.6) |
| Benign bile duct stricture | 10 (2.5) |
| Others (benign) | 16 (4.0) |
| Malignant disease | 137 (34.0) |
| Pancreatic cancer | 56 (13.9) |
| Cholangiocarcinoma | 72 (17.9) |
| Others (malignant) | 9 (2.2) |
| Malignant disease/benign disease | 137 (34.0)/266 (66) |
| Expert | 214 (53.1) |
| Peripapillary diverticulum | 107 (26.6) |
| Oral-side protrusion-L | 110 (27.3) |
Table 2 Overall treatment outcomes, n (%)
| Outcomes | n = 403 |
| Cannulation success rate | 99.2% (400/403) |
| Difficult cannulation | 147 (36.5) |
| Standard technique | 314 (77.9) |
| ACT | 89 (22.1) |
| Complications | 37 (9.2) |
| Hemorrhage | 4 (1.0) (mild) |
| PEP | 14 (3.5) |
| Mild/moderate/severe | 10/2/1 |
| Elevated amylase | 19 (4.7) |
| Amy level, median (range, U/L) | 79 (9-2705) |
| Others | 0 |
Table 3 Investigation of the occurrence of complications, n (%)
| Outcomes | Complications present | No complications | Univariate analysis | Logistic regression analysis (P value) | OR (95%CI) |
| Age median (range) | 79 (46-89) | 78 (29-104) | 0.78 | - | - |
| Sex (male/female) | 23/14 | 207/159 | 0.60 | - | - |
| Malignant disease | 11 (29.7) | 126 (34.4) | 0.72 | 0.162 | 0.552 (0.240-1.27) |
| Experts | 24 (64.9) | 190 (51.9) | 0.28 | 0.184 | 1.410 (0.668-2.970) |
| Periampullary diverticulum | 7 (18.9) | 100 (27.3) | 0.22 | 0.472 | 0.75 (0.43-1.28) |
| Oral protrusion-L | 14 (37.8) | 96 (35.6) | 0.17 | 0.713 | 0.848 (0.3510-2.050) |
| Difficult cannulation | 22 (59.5) | 125 (34.2) | 0.004 | 0.143 | 2.060 (0.784-5.080) |
| ACT | 20 (54.1) | 75 (20.5) | < 0.001 | 0.00169 | 5.405 (1.887-15.53) |
Table 4 Comparison of treatment outcomes between standard and advanced cannulation techniques, n (%)
| Outcomes | Standard cannulation techniques (n = 314) | ACTs (n = 89) | P value |
| Cannulation success rate (%) | 99.7% (313/314) | 97.8% (87/89) | 0.68 |
| Adverse events | 17 (5.4) | 20 (22.5) | < 0.001 |
| Hemorrhage | 3 (1.0) (mild) | 1 (1.1) (mild) | 0.633 |
| PEP | 5 (1.6) | 9 (10.1) | < 0.001 |
| Mild/moderate/severe | 5/0/0 | 6/2/1 | - |
| Amy level, median (range, U/L) | 79 (9-2709) | 113 (20-2632) | 0.018 |
| Elevated amylase | 9 (2.9) | 10 (11.2) | 0.003 |
| Others | 0 | 0 | NA |
Table 5 Comparison of patient backgrounds between standard and advanced cannulation techniques, n (%)
| Outcomes | Standard cannulation techniques (n = 314) | ACTs | Univariate analysis | Logistic regression analysis (P value) | OR (95%CI) |
| Age, median (range) | 78 (29-104) | 78 (46-96) | 1.00 | - | - |
| Sex (male/female) | 176/138 | 54/35 | 0.47 | - | - |
| Malignant disease | 89 (28.3) | 48 (53.9) | < 0.001 | < 0.001 | 2.58 (1.53-4.34) |
| Experts | 162 (51.6) | 52 (58.4) | 0.28 | 0.63 | 1.24 (0.76-1.84) |
| Peripapillary diverticulum | 88 (28.0) | 19 (21.3) | 0.22 | 0.47 | 0.76 (0.44-1.32) |
| Oral protrusion-L | 52 (16.6) | 58 (65.2) | < 0.001 | < 0.001 | 2.77 (1.65-4.65) |
Table 6 Details of the advanced cannulation technique, n (%)
| Outcomes | 2nd line (n = 89) | 3rd line (n = 11) |
| Double-guidewire technique | 31 (34.8) | - |
| Precut | 57 (64.0) | 11 (100) |
| Early precut | 48 (53.9) | - |
| Delayed precut | 9 (10.1) | 11 (100) |
| 2 devices in one channel technique | 1 (1.1) | - |
| EUS-rendezvous | 0 | 0 |
Table 7 Comparison of patient backgrounds between the early precut and the other advanced cannulation technique groups, n (%)
| Outcomes | Early precut (n = 48) | ACTs (n = 41) | P value |
| Age, median (range) | 78 (52-91) | 79 (41-95) | 0.808 |
| Sex (male/female) | 31/17 | 23/18 | 0.515 |
| Malignant disease | 34 (70.8) | 14 (34.1) | 0.001 |
| Oral protrusion-L | 35 (72.9) | 23 (56.1) | 0.120 |
| Peripapillary diverticulum | 7 (14.6) | 12 (29.2) | 0.121 |
| Expert | 29 (60.4) | 23 (56.1) | 0.829 |
| Pancreatic duct stent | 0 | 29 (70.1) | < 0.001 |
Table 8 Comparison of treatment outcomes between the early precut and other advanced cannulation technique groups, n (%)
| Outcomes | Early precut (n = 48) | Other ACTs (n = 41) | P value |
| Overall bile duct cannulation success rate | 97.9% (47/48) | 97.6% (40/41) | 1.00 |
| Success rate up to the 2nd line | 97.9% (47/48) | 73.2% (30/41) | 0.001 |
| Cannulation time, median (range, second) | 837 (242-2085) | 1287.5 (194-4526) | < 0.001 |
| No. of cannulation attempts, median (range) | 7 (2-15) | 8 (3-20) | < 0.001 |
| Procedure time, median (range, minute) | 31 (10-102) | 43 (13-135) | 0.007 |
| Complications | 4 (8.3) | 16 (39.0) | 0.001 |
| Hemorrhage | 0 | 1 (2.3) (mild) | 0.460 |
| PEP | 2 (4.2) | 7 (17.1) | 0.075 |
| Mild/moderate/severe | 2/0/0 | 4/2/1 | - |
| Elevated amylase | 2 (4.2) | 8 (19.5) | 0.0395 |
| Amy level median (range, U/L) | 102 (20-1045) | 160 (21-2632) | 0.021 |
Table 9 Comparison of treatment outcomes between the early precut and other advanced cannulation technique groups, limited to cases of oral protrusion-large, n (%)
| Outcomes | Early precut (n = 35) | Other ACTs (n = 23) | P value |
| Overall bile duct cannulation success rate | 97.1% (34/35) | 100% (23/23) | 1.0 |
| Success rate up to the 2nd line | 97.1% (34/35) | 65.2% (15/23) | 0.001 |
| Cannulation time (second) | 757.5 (242-2085) | 1764 (305-3437) | < 0.001 |
| No. of attempts | 7 (2-15) | 10 (3-20) | < 0.001 |
| Procedure time (minute) | 30 (10-69) | 58 (30-135) | 0.007 |
| Complications | 3 (8.6) | 10 (43.5) | 0.003 |
| Hemorrhage | 0 | 1 (4.3) (mild) | 0.40 |
| PEP | 1 (2.9) | 4 (17.4) | 0.075 |
| Mild/moderate/severe | 1/0/0 | 2/1/1 | - |
| Elevated amylase | 2 (5.7) | 5 (21.7) | 0.10 |
| Amy level Median (range, U/L) | 110 (20-895) | 193 (39-2632) | 0.021 |
Table 10 Comparison of treatment outcomes between the needle knife fistulotomy group and the needle knife papillotomy within the early precut group, n (%)
| NKF (n = 29) | NKP (n = 19) | P value | |
| Oral protrusion-L | 26 (89.7) | 9(47.4) | 0.002 |
| Overall bile duct cannulation success rate | 100% (29/29) | 94.7% (18/19) | 0.4 |
| Success rate up to the 2nd line | 100% (29/29) | 94.7% (18/19) | 0.4 |
| Cannulation time (second) | 757.5 (242-2085) | 902 (416-1450) | 0.896 |
| No. of attempts | 7 (2-15) | 7.5 (3-12) | 0.74 |
| Procedure time (minute) | 30 (10-69) | 32 (15-102) | 0.51 |
| Complications | 1 (3.4) | 3 (15.8) | 0.29 |
| Hemorrhage | 0 (0) | 0 (0) | 1 |
| PEP | 1 (3.4) | 1 (5.2) | 1 |
| Mild/moderate/severe | 1/0/0 | 1/0/0 | - |
| Elevated amylase | 0 | 2 (10.5) | 0.15 |
| Amy level | 130 (27-895) | 75 (20-1045) | 0.94 |
| Median (range, U/L) | |||
- Citation: Kaneko T, Kida M, Kurosu T, Kitahara G, Betto T, Saito Y, Koyama S, Nomura N, Kusano C. Early precut is useful for difficult bile duct cannulation, particularly in cases with long oral protrusion. World J Gastrointest Endosc 2025; 17(9): 108420
- URL: https://www.wjgnet.com/1948-5190/full/v17/i9/108420.htm
- DOI: https://dx.doi.org/10.4253/wjge.v17.i9.108420