Pure Cut Current for Biliary Sphincterotomy Is Associated With Less Delayed Bleeding and May Reduce Post-ERCP Pancreatitis Risk

Thermal injury from biliary sphincterotomy is thought to play a role in at least a proportion of post-ERCP pancreatitis (PEP) cases. Thus, the present study aimed to determine whether the use of a Pure cut current versus an EndoCUT (ERBE, Tubingen, Germany) current—a blend of cutting and coagulation currents—might decrease PEP rates by reducing thermal injury to the pancreas. 

In this study conducted at two centers, the authors randomized 550 patients with native papillae undergoing ERCP, with the intention for biliary sphincterotomy, to one of two electrosurgical settings, Pure cut or EndoCUT (EndoCUT I, effect 2, cutting duration 3, cutting interval 3), in a 1:1 fashion. Rectal nonsteroidal anti-inflammatory drugs (NSAIDs) were not utilized because they were not available to the centers during the study period. The primary outcome was PEP incidence. 

The overall PEP rate was 4.0% (all mild to moderate). On univariate analysis, the PEP rate was significantly higher with EndoCUT than with Pure cut (5.8% vs 2.2%; P=.034). Cannulation attempted more than 5 times was also a risk factor for PEP on univariate analysis. On multivariate analysis, only a higher number of cannulation attempts reached significance for PEP risk, with EndoCUT current use approaching significance (P=.052). Intraprocedural bleeding was significantly more common in the Pure cut group; however, delayed bleeding was more common in the EndoCUT group than the Pure cut group (4.3% vs 1.5%, respectively). Finally, only one uncontrolled sphincterotomy (zipper cut) occurred, and this was in the EndoCUT group.