Background. Transpancreatic precut sphincterotomy (TPS) is an option for difficult common bile duct (CBD) access, and the reports are few, with immediate success rate varying from 60 to 96%. The description of relation between the size of TPS and the immediate success rate of CBD cannulation was not found in the literature. The Aim of the Study. To evaluate the relation of large TPS to immediate success rate of CBD cannulation. Methods. A retrospective analysis was performed in prospectively collected data of 20 patients. TPS was performed with traction papillotome in the main pancreatic duct (MPD) directing towards 11 o’clock. Needle knife (NK) was used to enlarge TPS in five patients, and the other 15 cases had large TPS from the beginning of sphincterotomy. Prophylactic pancreatic stent was inserted in 18 cases, with diclofenac given in 12 cases. Results. The immediate success rate of CBD cannulation was 90% and with an eventual success rate of 100%. The failure in one immediate CBD cannulation with large TPS was due to atypical location of CBD orifice, and the other failed immediate CBD cannulation was due to inadequate size of TPS. Complications included 3 cases of post-TPS bleeding and 3 cases of mild pancreatitis. Conclusion. TPS is an effective procedure in patients with difficult biliary access and can have high immediate success rate with large TPS. 1. Introduction The initial success rate of selective CBD cannulation was reported to be 70% after a standard cannulation using guide wire and papillotome with the criteria of 5 attempts of cannulation [1]. Using double-guide wire (DGW) technique, the success rate varies from 47 to 73% with the pancreatitis rate of 14–38% [1–3]. Transpancreatic precut sphincterotomy (TPS) can be an alternative technique because the access is already in the MPD. The reports of TPS are few when compared to needle knife precut sphincterotomy, and detailed description of the size of TPS in relation to immediate successful CBD cannulation was not emphasized in the literature. The immediate success rate of TPS for biliary access varies from 60 to 96% [4, 5]. Diclofenac rectally administered and prophylactic pancreatic stent (PS) placement can reduce the incidence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) [6]. We evaluate the primary outcome of immediate success rate of CBD cannulation with large TPS and secondary outcome of the complications with this new technique in our hospital. 2. Materials and Methods Between January 2012 and October 2013, a retrospective analysis of prospectively
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