Precut (access) sphincterotomy

Precut sphincterotomy, or access papillotomy, refers to a variety of endoscopic sphincterotomy techniques used to gain access to the bile (and occasionally pancreatic) duct(s) when conventional cannulation methods have failed. This article reviews indications, patient selection, techniques, and outcomes of precut sphincterotomy. Major techniques for biliary access include freehand needle-knife sphincterotomy, needle-knife sphincterotomy after placement of a pancreatic stent, and the Erlangen pull-type precut. Success and complication rates of precut techniques are highly variable and depend heavily on the experience and skill of the endoscopist; the indication for the procedure; anatomic variations between patients; and probably on technique-related factors, such as the use of pancreatic stents in certain settings.