Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Factors Predicting Difficult Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography for Common Bile Duct Stones

  • Hirokazu Saito (Department of Gastroenterology, Kumamoto City Hospital) ;
  • Yoshihiro Kadono (Department of Gastroenterology, Tsuruta Hospital) ;
  • Takashi Shono (Department of Gastroenterology, Kumamoto Chuo Hospital) ;
  • Kentaro Kamikawa (Department of Gastroenterology, Saiseikai Kumamoto Hospital) ;
  • Atsushi Urata (Department of Gastroenterology, Saiseikai Kumamoto Hospital) ;
  • Jiro Nasu (Department of Gastroenterological Surgery, Kumamoto Chuo Hospital) ;
  • Haruo Imamura (Department of Gastroenterology, Saiseikai Kumamoto Hospital) ;
  • Ikuo Matsushita (Department of Gastroenterology, Kumamoto Chuo Hospital) ;
  • Tatsuyuki Kakuma (Department of Biostatics Center, Medical School, Kurume University) ;
  • Shuji Tada (Department of Gastroenterology, Kumamoto City Hospital)
  • Received : 2021.05.10
  • Accepted : 2021.07.02
  • Published : 2022.03.30
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Abstract

Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP. Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses. Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS. Conclusions: Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

Keywords

Acknowledgement

We would like to thank the staff at the participating institutions who are involved in ERCP.

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