Difficult Biliary Cannulation in the ERCP: Repeated Ercp After Precut, Percutaneous Or EUS Guided Alternative Procedure? Analysis in a Tertiary Care Center

Aims: Introduction ERCP is the standard procedure for biliary drainage. In case of difficult biliary access alternative procedures consist of precut intervention with repeated ERCP, percutaneous access or EUS guided intervention. We analyzed frequency and success rate of used procedures in the daily praxis.

Methods We analyzed all ERCP proc. from 1-2017 to 12-2019. Registered parameters were indication, first or repeated ERCP, performed intervention, house classification, anatomy, cannulation success, PEP rate.

Results 1610 ERCP procedures were undertaken (anatomy: 1564 normal; 46 postop.(Roux-y or BII)). Main indication was biliary (+/- pancreatic) in 95.6 % (1495) and pancreatic in 4.4 % (69). Distribution of house classification: Biliary (+/- pancreatic): House I n = 842, House II n =284, House III n= 363. Pancreatic: House II n = 55; House III N = 14.

40.5 % (633/1564) of patients with biliary indication had a naive papilla (Malign 26.4 %, CDL 59.9 %, benign stricture 4.4 %, bil. leakage 3.6 %, others 8,6 %). Success rate for biliary access during 1. ERCP was 87 % (553/633). No addidional interventions were performed in 14 patients (tumor referred to surgery 3; drop of cholestasis 11). Repeated ERC performed after precut leaded to successful cannulation in 86 % (2cond intervention (39/49) 3d intervention (3/4)).

Alternative procedures: Percutaneous access (PTCD) was performed in 5 patients after first ERC attempt; in 3 patients after 2cond ERC (malign obstruction 5/8). EUS guided biliary drainage in 16 patients after first ERC attempt (EUS-BD using LAMS: 15, EUS Rendezvous: 1) mainly in patients with malign obstruction (14/16).

Introduction of EUS guided biliary drainage in 2018 leaded to a decline of percutaneous procedures.

Conclusions Repeated ERC after precut technique succeeds in 86 % in case of primarily unsuccessful biliary access. EUS guided biliary drainage is an effective alternative especially in patients with malign obstruction.

Citation: Stathopoulos P, Lerner P, Astheimer P et al. OP32 DIFFICULT BILIARY CANNULATION IN THE ERCP: REPEATED ERCP AFTER PRECUT, PERCUTANEOUS OR EUS GUIDED ALTERNATIVE PROCEDURE? ANALYSIS IN A TERTIARY CARE CENTER. Endoscopy 2021; 53: S16.

Publication History

Article published online:
19 March 2021