Success of a Second ERCP After Failure of Initial Biliary Cannulation Following Precut Sphinctertomy, Efficacy and Safety of Alternative Biliary Drainage Techniques

Aims We evaluated the efficacy, safety of a second ERCP after failed cannulation with precut, percutaneous transhepatic biliary drainage (PTBD), and surgery; and factors related to the success of a second ERCP with failed precut.

Methods We reviewed all patients that underwent an ERCP with native papilla from January 2017 to December 2018 in our hospital. Efficacy was based on the cannulation rate of the second ERCP and the resolution of biliary obstruction in PTBD and surgery. Safety was assessed in terms of adverse events.

Results Out of 469 patients with a native papilla, we identified 50 patients with failed cannulation, was performed precut and a second ERCP in 27, that was successful in 21 (78 %). Periampullary duodenal diverticulum was found in 66 % of patients in which cannulation was not achieved (p = 0.03). After second ERCP, three of 27 patients (11 %) presented adverse events: one delayed bleeding, one pancreatitis, and one cholangitis. The median time between procedures was 4 days (IQR 3-4). The median hospital stay after second ERCP was 4 days (IQR 2-10). Of 11 patients who underwent PTBD post-failure in the first ERCP, technical success was achieved in 9 (82 %), with a median of 2 sessions and a median hospital stay of 7 days (RIQ 5-14). Seven patients (64 %) had adverse events (four cholangitis, two pancreatitis, and one bacteremia). Out of 3 patients who underwent surgery, technical success was achieved in all cases without presenting any complications until discharge. The median hospital stay was 6.5 days (IQR 4-10.5).

Conclusions A second ERCP after failure of initial biliary cannulation following a precut sphincterotomy appears to be safe, effective and is associated with fewer adverse effects than PTBD. The presence of a duodenal diverticulum is associated with a lower success rate in the second ERCP.

Citation: Castillo-Regalado E, Córdova H, Fernández-Simón A et al. OP33 SUCCESS OF A SECOND ERCP AFTER FAILURE OF INITIAL BILIARY CANNULATION FOLLOWING PRECUT SPHINCTERTOMY, EFFICACY AND SAFETY OF ALTERNATIVE BILIARY DRAINAGE TECHNIQUES. Endoscopy 2021; 53: S16.

Publication History

Article published online:
19 March 2021