Comparison between transpancreatic sphincterotomy and needle-knife precut in difficult cannulation of endoscopic retrograde cholangiopancreatography: an up-to-date meta-analysis and systematic review

Background Selective cannulation, which is essential for endoscopic retrograde cholangiopancreatography (ERCP), may be difficult. The aim of this study was to compare transpancreatic sphincterotomy (TPS) and needle-knife precut (NKP) in difficult cannulation during ERCP. Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched for relevant studies from January 1990 to April 2022. A meta-analysis focusing on cannulation success and post-ERCP complications was performed by Review Manager. Results Seventeen eligible studies involving 2340 patients were included. Our results showed that the TPS group had a higher cannulation success rate (odds ratio (OR) 0.48, 95% confidence interval (CI) 0.27-0.87, p = 0.02) and less bleeding (OR 1.94, 95% CI 1.09-3.47, p = 0.03) compared with the NKP group. There was no significant difference between NKP and TPS in the rates of post-ERCP pancreatitis (OR 0.83, 95% CI 0.59-1.18, p = 0.30), perforation (OR 2.04, 95% CI 0.69-6.03, p = 0.20), and adverse events (OR 1.29, 95% CI 0.94-1.77, p = 0.12). Conclusion TPS appears to be associated with a higher cannulation success rate and less bleeding than those with NKP, with equal post-ERCP pancreatitis, perforation, and adverse events rates between TPS and NKP. Further large-scale trials are warranted to support our findings.