Objective To evaluate the effect of transpancreatic pre-cut sphincterotomy on recurrence after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stone. MethodsA total of 102 patients with common bile duct stone who underwent ERCP stone extraction at Beijing Aerospace General Hospital from January 2022 to January 2024 were retrospectively collected. Using propensity score matching to adjust equilibrium, 45 patients were divided into the transpancreatic pre-cut sphincterotomy group and 45 were in the control group (standard cannulation method). Compare stone recurrence rate, surgical parameters, liver function indicators, inflammatory factors, oxidative stress markers and adverse events between the two groups. ResultsThe improvement of postoperative indicators of the transpancreatic pre-cut sphincterotomy group including total bilirubin [(5.18±1.30) μmol/L vs. (1.64±0.88) μmol/L, P<0.001], alkaline phosphatase [(16.45±4.82) U/L vs. (9.12±3.04) U/L, P<0.001], alanine aminotransferase [(6.83±2.21) U/L vs. (3.57±1.92) U/L, P<0.001], C-reactive protein [(3.34±1.15) mg/L vs. (1.53±0.87) mg/L, P<0.001], interleukin-6 [(5.72±1.90) pg/mL vs. (3.02±1.48) pg/mL, P<0.001], tumor necrosis factor-α [(6.84±2.35) pg/mL vs. (3.44±1.98) pg/mL, P<0.001], malondialdehyde [(2.40±0.79) nmol/mL vs. (1.16±0.72) nmol/mL, P<0.001], superoxide dismutase [(–17.36±5.52) U/mL vs. (–7.43±4.46) U/mL, P<0.001] were superior to the control group. The overall stone recurrence rate was lower in the transpancreatic pre-cut sphincterotomy group [11.11%(5/45) vs. 33.33%(15/45), P=0.011]. The adverse events rate was decreased in the transpancreatic pre-cut sphincterotomy group [22.22% (10/45) vs. 8.89% (4/45), P=0.037], accompanied by a reduced risk of adverse events [RR=0.523, 95%CI (0.280, 0.964)]. ConclusionTranspancreatic pre-cut sphincterotomy effectively reduces the risk of stone recurrence and adverse events following ERCP for common bile duct stone, while promoting postoperative recovery of liver function.