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

AIM： Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography （ERCP） for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS： Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS： Fifty-one patients （35 female; mean age： 62.5 years; age range： 40-87 years） with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis （45%） or pancreatic malignancy （18%）. Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy （NKS） rate was 27.4%. Complications occurred in 3.9% （post-ERCP pancreatitis）. An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients （female 61%; mean age： 59.9 years; age range： 18-94 years） who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate （100% vs 98%） or postERCP pancreatitis （3.1% vs 3.9%）. Precut NKS use was more frequent （27.4% vs 12.7%） （P = 0.017）. CONCLUSION： Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.