ERCP cannulation: a review of reported techniques

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“…The need to decrease costs in all healthcare systems has brought quality measurement to the forefront of modern medicine, endoscopy included [1,2]. High value endoscopy is positively correlated with an adequate training program [3,4].…”

“…High value endoscopy is positively correlated with an adequate training program [3,4]. Concerning endoscopic retrograde cholangiopancreatography (ERCP), the selective cannulation of the common bile duct (CBD) is one of the most demanding maneuvers that an interventional endoscopist is required to master [1,2]. Even among experienced endoscopists, biliary cannulation is unsuccessful in between 15 % and 30 % of cases, when only conventional methods are employed [3 -6].…”

“…A sustainable cannulation rate above 90 % implies the performance of alternative techniques of access, such as the precut. This rescue strategy consists of the incision of the papilla to facilitate access to the CBD [1,7]. Precut, in particular, needle-knife fistulotomy (NKF), increases the yield of cannulation and appears to be safe, when performed by experienced endoscopists [8,9].…”

“…ERCP is a complex endoscopic procedure established in the management of biliary and pancreatic disorders [16,20,21]. In order to assure high-quality endoscopy, the American Society for Gastrointestinal Endoscopy (ASGE) developed several quality indicators for ERCP [1,2,12,22]. Quality in ERCP lies in adequate training to learn the necessary technical and cognitive skills.…”

“…Subsequently, in 1986, Huibregtse et al reported a new precut technique, in which the incision of the papillary roof was performed by needle knife [1,7,25]. Needle-knife precut papillotomy (either the classic approach or NKF) is the most common option for achieving CBD cannulation during ERCP when endoscopists face difficult biliary cannulation [8,9,26,27].…”