Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. (June 2014)

• Record Type: Journal Article
• Authors: Halttunen, Jorma; Meisner, Søren; Aabakken, Lars; Arnelo, Urban; Grönroos, Juha; Hauge, Truls; Kleveland, Per M.; Nordblad Schmidt, Palle; Saarela, Arto; Swahn, Fredrik; Toth, Ervin; Mustonen, Harri; Löhr, J.-Matthias
• Is Part Of: Scandinavian journal of gastroenterology. Volume 49:Number 6(2014)
• Page Start: 752
• Page End: 758
• Publication Date: 2014-06
• Subjects: Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; 616.33
• DOI: 10.3109/00365521.2014.894120
• Languages: English
• ISSNs: 0036-5521

Abstract

<abstract> <title>Abstract</title> <p> <bold> <italic>Background.</italic> </bold> The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). <bold><italic>Aims.</italic></bold> To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. <bold><italic>Patients and methods.</italic></bold> Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. <bold><italic>Results.</italic></bold> The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and post-ERCP pancreatitis (PEP) rate was 5.3%. The median time for all successful cannulations was 1.55 min (range 0.02–94.2). If the primary cannulation succeeded, the pancreatitis rate was 2.8%; after secondary methods, it rose to 11.5%. Procedures lasting less than 5 min had a PEP rate of 2.6% versus 11.8% in those lasting longer. With one attempt, the PEP rate was 0.6%, with two 3.1%, with three to four 6.1%, and with five and more 11.9%. With one accidental pancreatic guide-wire passage, the risk of the PEP was 3.7%, and with two passages, it was 13.1%. <bold><italic>Conclusions.</italic></bold> If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded.</p> </abstract>