Cannulation time is a more accurate measure of cannulation difficulty in endoscopic retrograde cholangiopancreatography than the number of attempts

Abstract

Background: Cannulation of the common bile duct (CBD) is the initial and sometime challenging step in endoscopic retrograde cholangiopancreatography (ERCP) procedure. Endoscopists often use cannulation attempts and cannulation time to grade cannulation difficulty, but a standard system has yet to be established. The objective of this study was to compare cannulation times with numbers of cannulation attempts, as measures of cannulation difficulty.Methods: We conducted a prospective study in a tertiary referral center, enrolling 58 patients who were undergoing ERCP for a variety of indications. Cannulation time and the number of cannulation attempts were recorded for each patient. A subset of 14 ERCPs had two observers assessing attempts at cannulation. Cannulation time, number of attempts and inter-observer variability in assessment of attempts were compared and studied.Results: The degree of agreement between two the methods (cannulation times and number of cannulation attempts) was unacceptable. There were considerable discrepancies between attempt tallies from two observers but the mean difference was statistically insignificant.Conclusion: The grade of cannulation difficulty for a given ERCP procedure may differ when different methods are used (total cannulation time vs number of attempts); thus, grading by different methods should not be used interchangeably. Cannulation time is a more objective and more accurate assessment tool for grading cannulation difficulty than the number of attempts to cannulate the papilla.

Ercp Performance in a Tertiary Brazilian Center: Focus on New Risk Factors, Complications and Quality Indicators

“…The factors can be patient or procedure-related and behave sinergistically: female gender, young age, sphincter of Oddi dysfunction, previous pancreatitis, normal serum bilirubin, precut, pancreatic sphincterotomy, contrast injection in the pancreatic duct (PD), failure to insert a pancreatic stent and papillary balloon dilation. Difficult cannulation is also a risk factor for PEP and is defined as failure to deeply cannulate the biliary tract, after a predetermined interval and number of attempts (>3-5 guidewire passages or contrast injections in the PD) 8 , 16 , 27 , 36 , 38 , 40 .…”

Combination of two-hour post-endoscopic retrograde cholangiopancreatography amylase levels and cannulation times is useful for predicting post-endoscopic retrograde cholangiopancreatography pancreatitis

“…Tian et al[20] reported that cannulation time is a more accurate measure of cannulation difficulty in ERCP than other parameters. Moreover, Halttunen et al[21] reported that cannulation attempts lasting > 5 min may increase the incidence of PEP and that procedures lasting less than 5 min had a lower PEP rate (2.6%) than longer procedures (11.8%).…”

“…The degree of cannulation difficulty during ERCP procedures may differ when different methods are used (total cannulation time vs number of attempts); thus, grading scales used to evaluate the difficulty of performing ERCP via different methods should not be used interchangeably. Tian et al[20] reported that cannulation time is a more objective and accurate means of grading cannulation difficulty than the number of papilla cannulation attempts. The ESGE guidelines categorize pancreatic guidewire use and pancreatic injection as definite PEP risk factors.…”

Comparison between double‐guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation

“…Grade of cannulation difficulty for a given ERCP procedure may differ when different methods are used, so the question of how to evaluate the grade of cannulation difficulty has remained . However, time to cannulation is a more objective and more accurate assessment tool for grading cannulation difficulty than the number of attempts, so we recorded data of cannulation time in order to evaluate the difficulty of different methods …”