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document
Endoscopic sphincterotomy by using pure-cut electrosurgical current and the risk of post-ERCP pancreatitis : a prospective randomized trial . BACKGROUND It has been suggested that the use of pure-cut electrosurgical current for endoscopic sphincterotomy may reduce the risk of post-ERCP pancreatitis . The aim of this study was to determine whether pure-cut current reduces the risk of pancreatitis compared with blend current . METHODS Patients were randomly assigned to undergo sphincterotomy over a non-conductive guidewire with 30 W/sec pure-cut current or 30 W/sec blend-2 current by a blinded endoscopist . Serum amylase and lipase levels were determined 1 day before and within 24 hours after ERCP . Post-ERCP pancreatitis was the primary outcome of interest . Secondary outcomes were as follows : severity of immediate bleeding , as graded by a 3-point scale from 1 ( no bleeding ) to 3 ( injection or balloon tamponade therapy required to stop bleeding ) and evidence of delayed bleeding 24 hours after ERCP . Analyses were performed in intention-to-treat fashion . RESULTS A total of 246 patients were randomized ( 116 pure-cut current , 130 blend current ) . There were no differences in baseline characteristics between the groups . The overall frequency of post-ERCP pancreatitis was 6.9 % , with no significant difference in frequency between treatment arms ( pure cut , 7.8 % vs. blend , 6.1 % ; p = 0.62 ) . The difference in rates of pancreatitis between the two groups was 1.7 % : 95 % CI [ -4.8 % , 8.2 % ] . Six patients ( 2.4 % ) had delayed bleeding after ERCP , of which two required transfusion . There was a significant increase in minor bleeding episodes ( grade 2 ) in the pure-cut group ( p < 0.0001 ) . Delayed episodes of bleeding were equal ( n = 3 ) in each arm . CONCLUSIONS The type of current used when performing endoscopic sphincterotomy does not appear to alter the risk of post-ERCP pancreatitis . The selection of electrosurgical current for biliary endoscopic sphincterotomy should be based on endoscopist preference .
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Intervention_Physical
Endoscopic sphincterotomy
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Intervention_Physical
pure-cut electrosurgical current
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Intervention_Physical
sphincterotomy
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Intervention_Physical
pure-cut current
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Intervention_Surgical
sphincterotomy
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Intervention_Physical
current
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Intervention_Physical
endoscopic sphincterotomy
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Intervention_Physical
electrosurgical current
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Intervention_Physical
endoscopic sphincterotomy
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Outcome_Physical
pancreatitis
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Outcome_Physical
Post-ERCP pancreatitis
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Outcome_Adverse-effects
severity of immediate bleeding ,
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Outcome_Other
balloon
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Outcome_Adverse-effects
evidence of delayed bleeding
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Outcome_Physical
post-ERCP pancreatitis
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Outcome_Physical
pancreatitis
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Outcome_Adverse-effects
delayed bleeding
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Outcome_Adverse-effects
minor bleeding episodes
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Outcome_Adverse-effects
Delayed episodes of bleeding