First Cut, Then Blend: An Electrocautery Technique Affecting Bleeding at Sphincterotomy
18 October 2001 (online)
Background and Study Aims: The use of pure cut electrocautery current for endoscopic sphincterotomy lowers pancreatitis rates following endoscopic retrograde cholangiopancreatography (ERCP), but at the expense of greater localized bleeding which partially obscures the endoscopic view. We hypothesized that localized bleeding could be decreased by using blended current at the end of the sphincterotomy, without losing the benefit associated with pure cut current of lower post-ERCP pancreatitis benefit.
Patients and Methods: Patients undergoing sphincterotomy were randomly allocated to receive pure cut current alone or a sequential combination of pure cut then blended current. In the sequential combination patients, the first 75 - 80 % of the sphincterotomy was done using pure cut current at 30 W and the remainder completed at a blend 2 setting (pure cut plus coagulation current), also at 30 W.
Results: 142 patients were enrolled in the study. No statistical difference was noted between the two groups in the rates of overall pancreatitis or bleeding requiring transfusion. When comparing visible bleeding rates (more than a few drops), we found that there was significantly more bleeding (P < 0.05) in the pure cut group (31/75, 41 %) at the time of sphincterotomy compared with the sequential combination group (16/67, 23 %).
Conclusions: A sequential combination of pure cut and blended current for sphincterotomy caused less visible bleeding than pure cut alone. This occurred without a change in the rate of post-ERCP pancreatitis.
- 1 Cotton P B, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37 383-393
- 2 Sherman S, Ruffolo T A, Hawes R H, et al. Complications of endoscopic sphincterotomy. Gastroenterology. 1991; 101 1068-1075
- 3 Elta G H, Barnett J L, Wille R T, et al. Pure cut electrocautery current for sphincterotomy causes less post-procedure pancreatitis than blended current. Gastrointest Endosc. 1998; 47 149-153
- 4 Cotton P B, Williams C B.
Therapeutic endoscopic retrograde cholangiopancreatography (ERCP).In: Practical gastrointestinal endoscopy. 3rd edn. London; Blackwell, 1990: 118-156
- 5 Freeman M L, Nelson D B, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med. 1996; 335 909-918
- 6 Sherman S, Lehman G A.
Endoscopic retrograde cholangiopancreatography, endoscopic sphincterotomy and stone removal, and endoscopic biliary and pancreatic drainage.In: Yamada T, Alpers DH, Laine L, et al. (eds). Textbook of gastroenterology. 3rd edn. Philadelphia; Lippincott Williams and Wilkins, 1999: 2718-2746
- 7 Sherman S, Lehman G A. ERCP and endoscopic sphincterotomy-induced pancreatitis. Pancreas. 1991; 6 350-367
- 8 Mitchell J P. The principles of transurethral resection and hemostasis. Bristol, England; John Wright, 1972
- 9 Kelly H A, Ward G E. Electrosurgery. Philadelphia; WB Saunders, 1982
- 10 Dobbie A K. The electrical aspects of surgical diathermy. Biomed Eng. 1969; 7 206-216
- 11 Taunton J C. Surgical diathermy: a review. J Med Eng Technol. 1981; 5 175-183
- 12 Geenen J E. ASGE Distinguished Lecture - Endoscopic therapy of pancreatic disease: a new horizon. Gastrointest Endosc. 1988; 34 386-389
- 13 Tarnasky P R, Palesch Y Y, Cunningham J T, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction. Gastroenterology. 1998; 115 1518-1524
- 14 Geenen J E, Vennes J A, Silvis S E. Resume of a seminar on endoscopic retrograde sphincterotomy (ERS). Gastrointest Endosc. 1981; 27 31-38
- 15 Ratani R S, Mills T N, Ainley C C, et al. Electrophysical factors influencing endoscopic sphincterotomy. Gastrointest Endosc. 1998; 47 43-52
- 16 Freeman M L, Nelson D B, Sherman S, et al. Same-day discharge after endoscopic biliary sphincterotomy: observations from a prospective multicenter complication study. Gastrointest Endosc. 1999; 49 580-586
G. H. Elta, M.D.
Division of Gastroenterology
Dept. of Internal Medicine
3912 Taubman Center, Box 0362
Ann Arbor, MI 48109-0362
Fax: + 1-734-936-7392