Precut (needle knife) papillotomy for impacted common bile duct stone at the ampulla.

Twenty of 510 patients with common bile duct (CBD) stone underwent needle knife precut papillotomy after conventional papillotomy failed because of impacted ampullary stone. This facilitated deep cannulation and subsequent standard papillotomy in 12 patients. In four patients, the precut papillotomy was extended, resulting in spontaneous expulsion of stone. Bleeding precluded stone extraction in three patients, and these stones were removed at a second ERCP session. Ductal clearance was achieved in all except one patient who underwent surgical removal of the impacted stone. Mild bleeding occurred in four patients and was successfully controlled by endoscopic adrenalin injection. There was no perforation, pancreatitis, or exacerbation of cholangitis following the procedure.