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

Swan, Michael P.; Bourke, Michael J.; Williams, Stephen J.; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David C.

doi:10.3748/wjg.v17.i45.4993

Cited by 34 publications

(24 citation statements)

References 29 publications

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“…Furthermore, our success rate of 92%, although lower than desired, does not fall outside of the range reported in the literature for tertiary care centers, suggesting our method is an effective alternative. [13][14][15] On secondary analysis of our 32 unsuccessful procedures, there was no statistically significant difference found among all radiation parameters including FT, total radiation dose, DAP, and ED when compared with successful procedures. This suggests that these procedures were unsuccessful due to patient-related characteristics as opposed to the procedure-related use of fluoroscopic imaging.…”

Section: Discussionmentioning

confidence: 50%

Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy

Churrango

Deutsch²,

Dinneen³

et al. 2015

Journal of Clinical Gastroenterology

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Section: Discussionmentioning

confidence: 50%

Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy

Churrango

Deutsch²,

Dinneen³

et al. 2015

Journal of Clinical Gastroenterology

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“…Finally, referral to a high‐volume center following unsuccessful ERCP is effective. An Australian study demonstrated high success rates with a favorable adverse‐event rate compared to routine ERCP . In this prospective intention‐to‐treat analysis of 51 patients referred following recent unsuccessful ERCP, successful biliary cannulation was achieved in 100% of cases.…”

Section: Discussionmentioning

confidence: 93%

A modern approach to ERCP: maintaining efficacy while optimising safety

Nalankilli

Kannuthurai

Moss

2016

Digestive Endoscopy

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Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging and complications such as post-ERCP pancreatitis (PEP) remain a concern. Modern ERCP techniques aim to maintain efficacy and improve safety. There are limited data regarding efficacy and safety of ERCP carried out by a newly qualified practitioner using modern techniques. The aim of the present study was to conduct an ERCP practice audit and compare it with an Australian national survey in order to review the evidence base underlying modern ERCP practice.Methods: All ERCP carried out by a newly qualified practitioner, using prospectively collected data, from September 2011 to May 2015, were audited. Outcomes were compared to an Australiawide survey of ERCP practice. A literature review was carried out regarding recent developments in ERCP practice.Results: Audit results correlated well with national data. All 478 ERCP were therapeutic and had pre-procedure imaging. Wireguided biliary cannulation was used. Success rate was 97%. Overall adverse-event rate was 0.8%. Choledocholithiasis was the predominant indication (72%). Biliary cannulation was successful in 338 of 348 naiive papillae. Of these, there were 53 (16%) difficult cannulations but the needle-knife sphincterotomy (NKS) rate was low compared to national data (13% vs 33%). Rate of dual-wire cannulation technique was higher (87% vs 30%). Pancreatic duct stenting (done in 32 cases [70% of dual-wire cannulation cases]) and rectal indomethacin (25%) were used to reduce PEP risk.Conclusions: A newly qualified ERCP proceduralist achieved high success rates with minimal adverse events using modern techniques. Practice was consistent with national data, although dualwire cannulation technique was preferred to NKS. Evidence base for modern ERCP techniques was reviewed. ERCP efficacy and safety should be monitored by practice audit.

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“…Biliary cannulation cannot be achieved because of special anatomical features, inflammatory processes, and periampullary diverticula. Some authors assert that low-risk patients undergoing failed ERCP without other complications could be successfully and safely treated by repeated ERCP if referred to an experienced high-volume endoscopy center [16]. However, repeated ERCP is bound to increase patient burden and the incidence of ERCP-related complications.…”

Section: Discussionmentioning

confidence: 98%

Laparoscopic management after failed endoscopic stone removal in nondilated common bile duct

Zang

Yin

Zhang

et al. 2016

International Journal of Surgery

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

Abstract: 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.

Cited by 34 publications

References 29 publications

Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy

Minimizing Radiation Exposure During ERCP by Avoiding Live or Continuous Fluoroscopy

A modern approach to ERCP: maintaining efficacy while optimising safety

Laparoscopic management after failed endoscopic stone removal in nondilated common bile duct

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