Pure Cut or Endocut for Biliary Sphincterotomy? A Multicenter Randomized Clinical Trial

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Citações na Scopus
1
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
Dimensions
Título da Revista
ISSN da Revista
Título do Volume
Editora
LIPPINCOTT WILLIAMS & WILKINS
Autores
BRUNALDI, Vitor Ottoboni
QUEIROZ, Lucas Tobias Almeida
VIEIRA, Yuri Zamban
Citação
AMERICAN JOURNAL OF GASTROENTEROLOGY, v.118, n.10, p.1871-1879, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
INTRODUCTION: Adverse events (AE) after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and post-ERCP acute pancreatitis (PEP) is the most important one. Thermal injury from biliary sphincterotomy may play an important role and trigger PEP or bleeding. Therefore, this study evaluated the outcomes of 2 electric current modes used during biliary sphincterotomy. METHODS: From October 2019 to August 2021, consecutive patients with native papilla undergoing ERCP with biliary sphincterotomy were randomized to either the pure cut or endocut after cannulation. The primary outcome was PEP incidence. Secondary outcomes included intraprocedural and delayed bleeding, infection, and perforation. RESULTS: A total of 550 patients were randomized (272 pure cut and 278 endocut). The overall PEP rate was 4.0% and significantly higher in the endocut group (5.8% vs 2.2%, P = 0.034). Univariate analysis revealed >5 attempts (P = 0.004) and endocut mode (P = 0.034) as risk factors for PEP. Multivariate analysis revealed >5 attempts (P = 0.005) and a trend for endocut mode as risk factors for PEP (P = 0.052). Intraprocedural bleeding occurred more often with pure cut (P = 0.018), but all cases were controlled endoscopically during the ERCP. Delayed bleeding was more frequent with endocut (P = 0.047). There was no difference in perforation (P = 1.0) or infection (P = 0.4999) between the groups. DISCUSSION: Endocut mode may increase thermal injury leading to higher rates of PEP and delayed bleeding, whereas pure cut is associated with increased intraprocedural bleeding without clinical repercussion. The electric current mode is not related to perforation or infection. Further RCT assessing the impact of electric current on AE with overlapping preventive measures such as rectal nonsteroidal anti-inflammatory drugs and hyperhydration are needed. The study was submitted to the Brazilian Clinical Trials Platform (http://www.ensaiosclinicos.gov.br) under the registry number RBR-5d27tn.
Palavras-chave
ERCP, electric current, endocut, pancreatitis/PEP, pure cut
URI
https://observatorio.fm.usp.br/handle/OPI/59200
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC