Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

Table 1 Schutz grade for endoscopic retrograde cholangiopancreatography degree of difficulty for biliary procedures[11]

	Biliary procedures
Grade 1	Diagnostic cholangiogram
	Biliary cytology
	Standard sphincterotomy ± removal of stones < 10 mm
	Stricture dilatation/stent for extra-hepatic stricture
	or bile leak
Grade 2	Diagnostic cholangiogram with
	Billroth II anatomy
	Removal of CBD stones > 10 mm
	Stricture dilatation/stent for hilar tumors or benign intrahepatic strictures
Grade 3	SOD manometry
	Cholangioscopy
	Any therapy with Billroth II anatomy
	Removal of intrahepatic stones or any stones with lithotripsy

CBD: Common bile duct; SOD: Sphincter of Oddi dysfunction.

Table 2 Clinical indication for procedures n (%)

Indication	Tertiary referral cohort (n = 51)	Naïve papilla cohort (n = 940)	P value
Choledocholithiasis	23 (45.1)	446 (47.4)	0.78
Pancreatic malignancy	9 (17.7)	194 (20.6)	0.72
Benign biliary stricture/PSC	6 (11.8)	41 (4.4)	0.03
Bile leak	5 (9.8)	59 (6.3)	0.37
Cholangitis	4 (7.8)	57 (6.1)	0.48
Other (acute pancreatitis, suspected sphincter dysfunction)	4 (7.8)	143 (15.2)	0.22

PSC: Primary sclerosing cholangitis.

Table 3 Comparison of referred failed biliary cannulation ERCP and naïve papilla patients

	Non-referred naive papilla	Previous failed biliary cannulation	P value
No.	940	51
Mean age (yr)	62.5 (40-87)	59.9 (18-96)	NS
Sex (female:male)	69:31	61:39	NS
Cannulation attempts	3.2 (1-14)	2.96 (1-8)	NS
Time to cannulation	4.2 min (0.08-41)	4.4 min (0.8-13.5)	NS
Cannulation success	98%	100%	1.00
NKS rate	12.7%	27.4%	0.017
PEP	3.1%	3.9%	1.00
Other ERCP complication	Bleeding 0.5%	Nil
	Perforation 0.2%

ERCP: Endoscopic retrograde cholangiopancreatography; NKS: Needle knife sphincterotomy; PEP: Post-ERCP pancreatitis; NS: Not significant.