Needle-knife precut fistulotomy (NK-F) is a well-known rescue freehand technique for difficult biliary cannulation (DBC) during endoscopic retrograde cholangiopancreatography (ERCP). Another type, the Iso-Tome®, is a modified precutting device with an insulated oval needle tip to prevent direct electrical and thermal injury. However, few comparative studies of the efficacy of these two effective precut methods in DBC have been performed. This prospective comparative study aimed to evaluate the efficacy of the Iso-Tome® precut (IT-P) compared to NK-F in DBC.
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