Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers
- 26.01.2017
Erschienen in:
- Verfasst von
- 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
- Carlos Guarner
- Erschienen in
- Surgical Endoscopy | Ausgabe 9/2017
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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- Titel
- Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers
- Verfasst von
-
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
Carlos Guarner
- Publikationsdatum
- 26.01.2017
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 9/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-016-5410-z
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