Abstract
Difficulty in selectively inserting a papillotome into the bile duct remains a major clinical problem that has plagued endoscopists since the advent of endoscopic papillotomy. To deal with this problem, various techniques to access the bile duct have developed through a process of trial and error. Recently, the term "precut" is often heard at medical conferences. For endoscopists, the use of this word creates confusion because several slightly different procedures are available. This article describes the characteristics of different procedures to propose standardized terminology. An assessment of recent numbers of studies and patients indicates that the needle-knife technique and pancreatic sphincter precutting are mainly used to access the bile duct. Clinical studies indicate that pancreatic sphincter precutting has a slightly lower incidence of complications than the needle-knife technique. Recent reports indicate that pancreatic sphincter precutting is being performed in increasing numbers of patients. Whether placement of a pancreatic stent helps to prevent complications after either procedure should be addressed in future studies.
