Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2020; 26(41): 6391-6401
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6391
Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques
Monique T Barakat, Mohit Girotra, Nirav Thosani, Shivangi Kothari, Subhas Banerjee
Monique T Barakat, Divisions of Adult and Pediatric Gastroenterology and Hepatology, Stanford University Medical Center, Cupertino, CA 95014, United States
Mohit Girotra, Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Nirav Thosani, Department of Internal Medicine, Division of Gastroenterology, Hepatology & Nutrition, University of Texas Health Science Center Houston, Houston, TX 77030, United States
Shivangi Kothari, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14627, United States
Subhas Banerjee, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Stanford, CA 94304, United States
Author contributions: Barakat MT and Banerjee S were involved in conception and design of the study as well as collection and analysis of the data and initial draft of the manuscript; Barakat MT, Girotra M, Thosani N, Kothari S, and Banerjee S were involved in refined analysis and interpretation of the data, and critical revision of the article for important intellectual content; Banerjee S granted final approval of the article.
Institutional review board statement: The study was reviewed and approved by the Stanford University Medical Center Institutional Review Board (Approval #36658).
Conflict-of-interest statement: None of the authors of this manuscript have relevant conflicts of interest to disclose. 
Data sharing statement: No additional data are available. 
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:
Corresponding author: Subhas Banerjee, MD, Full Professor, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, United States.
Received: July 9, 2020
Peer-review started: July 9, 2020
First decision: September 12, 2020
Revised: September 22, 2020
Accepted: October 13, 2020
Article in press: October 13, 2020
Published online: November 7, 2020
Core Tip

Core Tip: At our tertiary care academic medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography (ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increasing endoscopist experience and ERCP volume. We therefore formally evaluated this phenomenon and underlying factors. We found that complexity of cannulation at ERCP has sharply increased over the past 5 years, with more elderly patients and those with malignancy requiring advanced cannulation techniques. These data suggest that cannulation complexity may be predicted based on patient/ampulla characteristics.