BACKGROUND AND STUDY AIMS: Precut sphincterotomy increases the success of deep biliary cannulation, but the method fails at the initial ERCP in 5-12% of cases. Although other invasive strategies are often used to access the bile duct, a second ERCP may be effective and safe. We evaluated the efficacy, safety, and factors related to a second ERCP after failed cannulation using a precut sphincterotomy. PATIENTS AND METHODS: We reviewed all patients that underwent an ERCP with native papilla from 2006 to 2014 at two tertiary institutions. Efficacy was based on the cannulation rate of the second ERCP, and safety was assessed in terms of adverse events. RESULTS: We identified 112 patients with failed cannulation after precut, and a second ERCP was performed in 72 (64.3%). Median time between procedures was 7 days (IQR 5-11). Deep cannulation was achieved in 54 cases (75%). The only factor associated with cannulation failure was an ERCP within 4 days after the initial precut (cannulation success 44.4 vs. 79.4% after 4 days, p = 0.026). Adverse events were recorded after the first ERCP in 13 of 112 patients (11.8%): delayed bleeding in four, pancreatitis in five, and perforation in four. After the second ERCP, three of 72 patients (4.2%) presented adverse events: two delayed bleeding and one pancreatitis. CONCLUSIONS: A second ERCP after failure of initial biliary cannulation following precut appears to be safe and effective. A second ERCP should be delayed at least 4 days if feasible.
BACKGROUND AND STUDY AIMS: Precut sphincterotomy increases the success of deep biliary cannulation, but the method fails at the initial ERCP in 5-12% of cases. Although other invasive strategies are often used to access the bile duct, a second ERCP may be effective and safe. We evaluated the efficacy, safety, and factors related to a second ERCP after failed cannulation using a precut sphincterotomy. PATIENTS AND METHODS: We reviewed all patients that underwent an ERCP with native papilla from 2006 to 2014 at two tertiary institutions. Efficacy was based on the cannulation rate of the second ERCP, and safety was assessed in terms of adverse events. RESULTS: We identified 112 patients with failed cannulation after precut, and a second ERCP was performed in 72 (64.3%). Median time between procedures was 7 days (IQR 5-11). Deep cannulation was achieved in 54 cases (75%). The only factor associated with cannulation failure was an ERCP within 4 days after the initial precut (cannulation success 44.4 vs. 79.4% after 4 days, p = 0.026). Adverse events were recorded after the first ERCP in 13 of 112 patients (11.8%): delayed bleeding in four, pancreatitis in five, and perforation in four. After the second ERCP, three of 72 patients (4.2%) presented adverse events: two delayed bleeding and one pancreatitis. CONCLUSIONS: A second ERCP after failure of initial biliary cannulation following precut appears to be safe and effective. A second ERCP should be delayed at least 4 days if feasible.
Authors: Janak N Shah; Fernando Marson; Frank Weilert; Yasser M Bhat; Thai Nguyen-Tang; Richard E Shaw; Kenneth F Binmoeller Journal: Gastrointest Endosc Date: 2011-10-21 Impact factor: 9.427
Authors: Juan J Vila; Manuel Pérez-Miranda; Enrique Vazquez-Sequeiros; Monder Abu-Suboh Abadia; Antonio Pérez-Millán; Ferrán González-Huix; Joan Gornals; Julio Iglesias-Garcia; Carlos De la Serna; José R Aparicio; José C Subtil; Alberto Alvarez; Felipe de la Morena; Jesús García-Cano; María A Casi; Angel Lancho; Angel Barturen; Santiago J Rodríguez-Gómez; Alejandro Repiso; Diego Juzgado; Francisco Igea; Ignacio Fernandez-Urien; Juan A González-Martin; José R Armengol-Miró Journal: Gastrointest Endosc Date: 2012-09-26 Impact factor: 9.427
Authors: Michael Pavlides; Ashley Barnabas; Nilesh Fernandopulle; Adam A Bailey; Jane Collier; Jane Phillips-Hughes; Anthony Ellis; Roger Chapman; Barbara Braden Journal: World J Gastroenterol Date: 2014-09-28 Impact factor: 5.742
Authors: H-U Laasch; A Tringali; L Wilbraham; A Marriott; R E England; M Mutignani; V Perri; G Costamagna; D F Martin Journal: Endoscopy Date: 2003-08 Impact factor: 10.093