Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers

Colán-Hernández, Juan; Aldana, Alexandra; Concepción, Mar; Chavez, Karina; Gómez, Cristina; Mendez-Bocanegra, Angela; Martínez-Guillén, Miguel; Sendino, Oriol; Villanueva, Càndid; Llach, Josep; Guarner–Argente, Carlos; Cárdenas, Andrés; Guarner, Carlos

doi:10.1007/s00464-016-5410-z

Cited by 24 publications

(27 citation statements)

References 23 publications

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“…In 9 studies that analyzed the role of repeat attempt at ERCP (▶ Table e5, available online), repeat ERCP was successful in 442 of 537 patients (82 %). Of note, the three studies that analyzed the timing of repeat ERCP found that ERCP was more frequently successful if it was repeated at least 2 days [129,131] or 4 days [127] after the first attempt. A suggested explanation includes better visualization of the opening of the bile duct because of decreased edema or disappearance of submucosal injection.…”

Section: Repeat Attempts At Ercpmentioning

confidence: 99%

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

et al. 2018

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ESGE recommends against routine preoperative biliary drainage in patients with malignant extrahepatic biliary obstruction; preoperative biliary drainage should be reserved for patients with cholangitis, severe symptomatic jaundice (e. g., intense pruritus), or delayed surgery, or for before neoadjuvant chemotherapy in jaundiced patients. Strong recommendation, moderate quality evidence. ESGE recommends the endoscopic placement of a 10-mm diameter self-expandable metal stent (SEMS) for preoperative biliary drainage of malignant extrahepatic biliary obstruction. Strong recommendation, moderate quality evidence.ESGE recommends SEMS insertion for palliative drainage of of extrahepatic malignant biliary obstruction. Strong recommendation, high quality evidence. ESGE recommends against the insertion of uncovered SEMS for the drainage of extrahepatic biliary obstruction of unconfirmed etiology. Strong recommendation, low quality evidence. ESGE suggests against routine preoperative biliary drainage in patients with malignant hilar obstruction. Weak recommendation, low quality evidence.ESGE recommends uncovered SEMSs for palliative drainage of malignant hilar obstruction. Strong recommendation, moderate quality evidence.ESGE recommends temporary insertion of multiple plastic stents or of a fully covered SEMS for treatment of benign biliary strictures. Strong recommendation, moderate quality evidence.ESGE recommends endoscopic placement of plastic stent(s) to treat bile duct leaks that are not due to transection of the common bile duct or common hepatic duct. Strong recommendation, moderate quality evidence.

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Section: Repeat Attempts At Ercpmentioning

confidence: 99%

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

et al. 2018

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“…Despite advances and new developments in endoscopic accessories such as endoscopic instruments, selective biliary cannulation fails in %5-15 of cases, even in expert, high-volume centers [11]. Repeating ERCP within a few days of the first failed pre-incision reduces the risk of complications by reducing the edema of the papilla and increases the chance of cannulation [12][13][14][15]. In our study, cannulation was performed with a sphincterotome in 563 (95.2%) of 591 patients without diverticula, 28 (90.3%) of 31 type I patients, 76 (88.3%) of 86 type II patients and 144 (92.3%) of 156 type III patients.…”

Section: Discussionmentioning

confidence: 99%

Complications increase in which type of duodenal diverticulum? A retrospective cohort study

Akaydın¹,

Akay²,

Leblebici³

2020

Journal of Surgery and Medicine

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Committee with the decision numbered 2013-KAEK-64. All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Bu çalışma Sağlık Bakanlığı İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu tarafından 11.03.2020 tarihinde 2013-KAEK-64 sayılı kararla onaylanmıştır. İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.

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“…To achieve maximum effectiveness, the endoscopist should consider the following steps after a failed cannulation attempt: (1) Describe the anatomy of the papilla and characterize it (floppy, flat, mobile, ob- scure, and swollen), ( 2) describe the mucosa overlying the channel and make an incision over the mucosa to expose the superior border of the bile duct, (3) describe the bile duct and perforate it until observing the bile stained flow, and (4) continue the procedure with standard sphincterotome and guidewire. [6] Swan et al [16] reported that, in cases of cannulation failure, referral to experienced, high-volume, tertiary centers resulted in a high success rate and a better outcome for patients. In the present study, 47 patients were referred from other hospitals following a failed ERCP, 46 of whom were cannulated successfully at the second attempt at our center.…”

Section: Figure 2 Severely Edematous and Swollen Papillamentioning

confidence: 99%

“…[3] Repeating ERCP within a few days after the initial unsuccessful precut is a successful strategy and should be attempted before contemplating more invasive, alternative interventions, such as percutaneous-endoscopic or endoscopic ultrasound-guided rendezvous procedure, percutaneous transhepatic, or surgical intervention. [4][5][6][7][8][9][10] However, there is still no consensus regarding the clinical outcomes of failed ERCP patients who underwent precut sphincterotomy. In the current work, we present the therapeutic approach and the outcomes of our patients with failed ERCP due to several reasons.…”

Section: Introductionmentioning

confidence: 99%

Steps to be considered in the unsuccessful ERCP pre-criteria: Early pre-cut intervention. A Retrospective Cohort Study

Akay¹

2021

Laparosc Endosc Surg Sci

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Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure for the treatment of several hepatobiliary and pancreatic diseases and also for diagnostic purposes of rare conditions. Despite advances in endoscopic accessories, selective biliary cannulation fails in 5-15% of cases, even in expert high-volume centers. However, there is still no consensus regarding the clinical outcomes of failed ERCP patients who underwent precut sphincterotomy. In the current work, we present the therapeutic approach and the outcomes of our patients with failed ERCP due to several reasons. Materials and Methods: There were 1986 patients who were referred from another center due to primary ERCP requirement (n=1862) or unsuccessful attempts to study at the primary center (n=124). If the papilla has prerequisite criteria for failed ERCP, then the procedure was begun directly with precut incision. Results:The ERCP procedure was successfully performed in all 1794 patients using a classic cannulation procedure. Pre-cut sphincterotomy method was successfully performed in 160 patients. There were 123 patients diagnosed by ERCP in our center and 103 of them were cannulated successfully with pre-cut sphincterotomy method. Pancreatitis developed in 12 of the 1794 patients (0.66%) whose primary cannulation was successful. However, only two of the 160 patients (1.25%) who underwent precut sphincterotomy developed pancreatitis postoperatively. One of these two patients had undergone unsuccessful precut trials. Conclusion:The cannulation rate depends on the experience, the referral center where the procedure is carried out, the anatomical structure of the papilla, the indication necessitating the ERCP, and also the use of precut incision. In cannulation failure, patients should be directed to experienced, high-volume, and tertiary centers. In patients with failed ERCP pre-criteria, intervention should be initiated with the liberal use of the precut method. In unsuccessful cannulation, a 3-day waiting period reduces complications.

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Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers

Abstract: 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.

Cited by 24 publications

References 23 publications

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017

Complications increase in which type of duodenal diverticulum? A retrospective cohort study

Steps to be considered in the unsuccessful ERCP pre-criteria: Early pre-cut intervention. A Retrospective Cohort Study

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