Bile duct cannulation : success rates for various ERCP techniques and devices at a single institution

Deep bile duct cannulation is the first step in carrying out ERCP biliary interventions. Although many special techniques have been described, there is a lack of reports that describe all methods employed to cannulate in a single series. This is a prospective study about the way in which cannulation was achieved in an ordinary ERCP workload. From January 2002 to June 2004, all patients who underwent ERCP with accessible and intact papilla and no gastroduodenal surgical alterations were included. Cannulation either with a 5.5 french tapered, triple lumen sphincterotome (5.5 Fr-S), loaded with a 0.035 inch hydrophilic tip guidewire, or with a 3 french tapered, double lumen sphincterotome (3 Fr-S), plus a 0.025 inch guidewire, was considered standard cannulation (SC). Other methods and devices were considered to be alternative methods. Of the 199 patients, SC succeeded in 150 (75.4%). Initial cannulation was achieved in 78/100 with the 3 Fr-S, and in 59/96 (61.4%) with the 5.5 Fr-S, (p = 0.01). Alternative methods used to reach a final 98% success rate were any type of precut (23 patients, 11.5%), cannulation above a pancreatic placed guidewire (11, 5.5%), above a pancreatic stent (7, 3.5%), utilization of two devices at the same time (3, 1.5%), and papillectomy (1, 0.5%). In 4 (2%) patients, cannulation failed. In almost a quarter of the patients (45, 22.6%) in this series, cannulation had to be performed by alternative methods. A 3 Fr-S is a very useful tool for gaining access to the bile duct.