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Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers

Surgical Endoscopy volume 31, pages 3711–3717 (2017)Cite this article

Abstract

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.

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Acknowledgments

Dr. C. Guarner-Argente received financial support from the Societat Catalana de Digestologia (Beca de intensificació per a la Recerca 2015). The authors thank C. Newey for help in editing the manuscript.

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Affiliations

  1. Servei de Patologia Digestiva, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, C/San Quintí, 89, 08041, Barcelona, Spain

    Juan Colan-Hernandez, Mar Concepción, Cristina Gómez, Miguel Martínez-Guillen, Càndid Villanueva, Carlos Guarner-Argente & Carlos Guarner

  2. Hospital Clinic, Universitat de Barcelona, Barcelona, Spain

    Alexandra Aldana, Karina Chavez, Angela Mendez-bocanegra, Oriol Sendino, Josep Llach & Andrés Cárdenas

  3. CIBERehd, Barcelona, Spain

    Càndid Villanueva & Carlos Guarner

Authors
  1. Juan Colan-Hernandez
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  2. Alexandra Aldana
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  3. Mar Concepción
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  4. Karina Chavez
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  5. Cristina Gómez
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  6. Angela Mendez-bocanegra
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  7. Miguel Martínez-Guillen
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  8. Oriol Sendino
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  9. Càndid Villanueva
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  11. Carlos Guarner-Argente
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  13. Carlos Guarner
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Corresponding author

Correspondence to Carlos Guarner-Argente.

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Disclosures

Juan Colan-Hernandez, Alexandra Aldana, Mar Concepción, Karina Chavez, Cristina Gómez, Angela Mendez-bocanegra, Miguel Martínez-Guillen, Oriol Sendino, Càndid Villanueva, Josep Llach, Carlos Guarner-Argente, Andrés Cárdenas, and Carlos Guarner have no conflicts of interest or financial ties to disclose.

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Colan-Hernandez, J., Aldana, A., Concepción, M. et al. Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers. Surg Endosc 31, 3711–3717 (2017). https://doi.org/10.1007/s00464-016-5410-z

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Keywords

  • Endoscopic retrograde cholangiopancreatography
  • ERCP
  • Difficult biliary cannulation
  • Precut
  • Needle–knife
  • Sphincterotomy