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CC BY-NC-ND 4.0 · Endosc Int Open
DOI: 10.1055/a-2325-3821
Review

Pure cut vs. Endocut in endoscopic biliary sphincterotomy: A systematic review and meta-analysis of Randomized Clinical Trials.

Luiza Bicudo de Oliveira 
1   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, University of Sao Paulo Hospital of Clinics, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Mateus Pereira Funari 
2   Endoscopy FMUSP, Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
3   USP, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Angelo So Taa Kum 
4   Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
,
Alexandre de Moraes Bestetti
5   Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Vitor Ottoboni Brunaldi 
6   Gastrointestinal Endoscopy Unit, Gastroenterology Department, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil (Ringgold ID: RIN37884)
,
Tomazo Antonio Prince Franzini
7   Gastrointestinal Endoscopy Unit, Gastroenterology Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Eduardo Turiani Hourneaux Moura
8   Gastrointestinal Endoscopy Unit - Gastroenterology Department, University of Sao Paulo Medical Schol, Sao Paulo, Brazil
,
Luiza Martins Baroni
7   Gastrointestinal Endoscopy Unit, Gastroenterology Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Matheus Ferreira de Carvalho
7   Gastrointestinal Endoscopy Unit, Gastroenterology Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
,
Wanderley Marques Bernardo 
9   Thoracic Surgery Department, University Sao Paulo Medical School – São Paulo – Brazil, SAO PAULO, Brazil
,
Eduardo Guimarães Hourneaux de Moura 
10   Gastrointestinal Endoscopy Department, Universidade de Sao Paulo Hospital das Clinicas, Sao Paulo, Brazil (Ringgold ID: RIN117265)
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Introduction: Biliary sphincterotomy is a crucial step in endoscopic retrograde cholangiopancreatography (ERCP), a procedure known to carry a 5-10% risk of complications. The relationship between Pure cut, Endocut, post-ERCP pancreatitis (PEP) and bleeding is unclear. This systematic review and meta-analysis compares these two current types and their relationships with adverse events. Methods: This systematic review involved searching articles in multiple databases until August 2023 comparing pure cut versus Endocut in biliary sphincterotomy. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: A total of 987 patients from four randomized controlled trials were included. Overall pancreatitis: a higher risk of pancreatitis was found in the Endocut group than in the pure cut group (P=0.001, RD=0,04 [0.01,0.06]; I2=29%). Overall immediate bleeding: statistical significance was found to favour Endocut, (P=0.05; RD=-0.15 [-0.29, -0.00]; I2=93%). No statistical significance between current modes was found in immediate bleeding without endoscopic intervention (P=0.10; RD=-0.13 [-0.29, 0.02]; I2=88%), immediate bleeding with endoscopic intervention (P=0.06; RD=-0.07 [-0.14,0,00]; I2=76%), delayed bleeding (P=0.40; RD=0.01 [-0.02,0.05]; I2=72%), zipper cut (P=0.58; RD= -0.03 [-0.16,0.09]; I2= 97%), perforation (P= 1.00; RD= 0.00 [-0.01,0.01]; I2= 0%) and cholangitis (P= 0.77; RD= 0.00 [-0.01,0.02]; I2= 29%). Conclusion: The available data in the literature shows that Endocut carries an increased risk for PEP and does not prevent delayed or clinically significant bleeding, although it prevents intraprocedural bleeding. Based on such findings, pure cut should be the preferred electric current mode for biliary sphincterotomy.



Publication History

Received: 22 December 2023

Accepted after revision: 12 April 2024

Accepted Manuscript online:
13 May 2024

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