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World J Gastroenterol. Aug 7, 2022; 28(29): 3803-3813
Published online Aug 7, 2022. doi: 10.3748/wjg.v28.i29.3803
Endoscopic salvage therapy after failed biliary cannulation using advanced techniques: A concise review
Yung-Kuan Tsou, Kuang-Tse Pan, Mu Hsien Lee, Cheng-Hui Lin
Yung-Kuan Tsou, Mu Hsien Lee, Cheng-Hui Lin, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Yung-Kuan Tsou, Kuang-Tse Pan, Mu Hsien Lee, Cheng-Hui Lin, Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Kuang-Tse Pan, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
Author contributions: Tsou YK conceptualized and designed the review and wrote the manuscript; Pan KT was responsible for the data acquisition/analysis of the percutaneous-transhepatic-endoscopic rendezvous procedures; Lee MH was responsible for the data acquisition/analysis of the endoscopic ultrasound-assisted or guided procedures; Lin CH contributed to revising and validating the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors contributing their efforts to this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Hui Lin, MD, Doctor, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5 Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan. linchehui@adm.cgmh.org.tw
Received: February 13, 2022
Peer-review started: February 13, 2022
First decision: April 5, 2022
Revised: April 15, 2022
Accepted: July 5, 2022
Article in press: July 5, 2022
Published online: August 7, 2022
Abstract

Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) begins with successful biliary cannulation. However, it is not always be successful. The failure of the initial ERCP is attributed to two main aspects: the papilla/biliary orifice is endoscopically accessible, or it is inaccessible. When the papilla/biliary orifice is accessible, bile duct cannulation failure can occur even with advanced cannulation techniques, including double guidewire techniques, transpancreatic sphincterotomy, needle-knife precut papillotomy, or fistulotomy. There is currently no consensus on the next steps of treatment in this setting. Therefore, this review aims to propose and discuss potential endoscopic options for patients who have failed ERCP due to difficult bile duct cannulation. These options include interval ERCP, percutaneous-transhepatic-endoscopic rendezvous procedures (PTE-RV), and endoscopic ultrasound-assisted rendezvous procedures (EUS-RV). The overall success rate for interval ERCP was 76.3% (68%-79% between studies), and the overall adverse event rate was 7.5% (0-15.9% between studies). The overall success rate for PTE-RV was 88.7% (80.4%-100% between studies), and the overall adverse event rate was 13.2% (4.9%-19.2% between studies). For EUS-RV, the overall success rate was 82%-86.1%, and the overall adverse event rate was 13%-15.6%. Because interval ERCP has an acceptably high success rate and lower adverse event rate and does not require additional expertise, facilities, or other specialists, it can be considered the first choice for salvage therapy. EUS-RV can also be considered if local experts are available. For patients in urgent need of biliary drainage, PTE-RV should be considered.

Keywords: Difficult biliary cannulation, Endoscopic ultrasound, Rendezvous, Endoscopic retrograde cholangiopancreatography, Percutaneous transhepatic biliary drainage, Interval

Core Tip: Three endoscopic salvage therapies are available for endoscopic retrograde cholangiopancreatography (ERCP) cannulation failure, but consensus is lacking. This review found that interval ERCP had an overall success rate of 76.3% and an adverse event rate of 7.5%. Percutaneous-transhepatic-endoscopic rendezvous procedure (PTE-RV) had an overall success rate of 88.7% and an adverse event rate of 13.2%. Endoscopic ultrasound-assisted rendezvous procedures (EUS-RV) had an overall success rate of 82%-86.1% and an adverse event rate of 13%-15.6%. Interval ERCP may be preferred, but EUS-RV may also be considered if a local expert is available. PTE-RV is reserved for patients requiring urgent biliary drainage.