Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 7, 2011; 17(45): 4993-4998
Published online Dec 7, 2011. doi: 10.3748/wjg.v17.i45.4993
Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography
Michael P Swan, Michael J Bourke, Stephen J Williams, Sina Alexander, Alan Moss, Rick Hope, David Ruppin
Michael P Swan, Michael J Bourke, Stephen J Williams, Sina Alexander, Alan Moss, Rick Hope, David Ruppin, Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney 2145, Australia
Author contributions: Swan MP designed the study, wrote the manuscript and performed some of the procedures; Bourke MJ and Williams SJ supervised all procedures and performed some of the procedures; Bourke MJ designed the study and assisted in the writing of the manuscript; Alexander S and Moss A collected data and assisted in the care of patients; Ruppin D and Hope R performed some of the procedures.
Correspondence to: Dr. Michael J Bourke, Director of Gastrointestinal Endoscopy, Department of Gastroenterology and Hepatology, Westmead Hospital, Hawkesbury Road, Sydney 2145, Australia. michael@citywestgastro.com.au
Telephone: +61-2-96335055 Fax: +61-2-96333958
Received: February 10, 2011
Revised: May 26, 2011
Accepted: June 2, 2011
Published online: December 7, 2011
Abstract

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center.

METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP.

RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017).

CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

Keywords: Failed endoscopic retrograde cholangiopancreatography; Failed biliary cannulation; Unsuccessful biliary cannulation; Tertiary referral endoscopic retrograde cholangiopancreatography; Needle knife sphincterotomy; Biliary cannulation; Precut sphincterotomy; Post endoscopic retrograde cholangiopancreatography pancreatitis