The definition of a “difficult” cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP).
Dr Jorma Halttunen and colleagues from Finland defined a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis.
The team evaluated prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists.
The team included patients with an indication for biliary access with intact papilla, and excluded those with an acute non-biliary and chronic pancreatitis at time of procedure.
The primary cannulation succeeded in 75%, with median values for time 0.88 minutes, with 2 attempts, and with zero pancreatic passages or injections.
The overall cannulation success was 97%, and post-ERCP pancreatitis rate was 5%.
|Procedures lasting less than 5 minutes had a post-ERCP pancreatitis rate of 3% |
|Scandanavian Journal of Gastroenterology|
The researchers found that the median time for all successful cannulations was 1.55 minutes.
If the primary cannulation succeeded, the pancreatitis rate was 3%.
After secondary methods, the team observed that it rose to 12%.
Procedures lasting less than 5 minutes had a post-ERCP pancreatitis rate of 3% versus 12% in those lasting longer.
With 1 attempt, the post-ERCP pancreatitis rate was 0.6%, with 2 it was 3%, with 3 to 4 it was 6%, and with 5 and more the post-ERCP pancreatitis rate was 12%.
The team found that with 1 accidental pancreatic guide-wire passage, the risk of the post-ERCP pancreatitis was 4%, and with 2 passages, it was 13%.
Dr Halttunen's team concludes, "If the increasing rate of post-ERCP pancreatitis is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 minutes, 5 attempts, and 2 pancreatic guide-wire passages when any of those limits is exceeded."