Predictors Of Failure Of Papilla Cannulation During Ercp For Common Bile Duct Stones

Aims Duodenal papilla cannulation is the first step in endoscopic retrograde cholangiopancreatography (ERCP). When cannulation of the papilla is difficult, it increases the risk of post-ERCP complications. In this case, the use of second-line endoscopic techniques should be considered (precut, infundibulotomy). The objective of this study was to determine the predictors of failure of papilla cannulation during ERCP for common bile duct (CBD) stones.

Methods This is a retrospective study that included all patients who had ERCP for common bile duct stones between January 2014 and December 2017. Patients with bilio-pancreatic tumor or with coagulation disorders were not included in the study. Epidemiological, clinical and para-clinical data were collected and predictive factors for failure of papilla catheterization were sought by univariate analysis (SPSS software, p significant if <0.05).

Results We included 181 patients whose mean age was 64 years [22-103 years] with a sex ratio M/W = 0.41. The main indications for ERCP were residual or recurrent lithiasis (69 %, n = 129) or sequential treatment (18 %, n = 33). Cannulation of the papilla by standard techniques could be performed in 127 patients (70.1 %). In patients whose papilla could not be cannulated by standard techniques, a precut was successfully performed in 15 patients. Eleven patients had infundibulotomy and five patients had CBD cannulation through a bilio-digestive fistula. In univariate analysis, the predictors of failure of papilla cannuation (before precut or infundibulotomy) were: a small papilla (p = <10-3), an eccentric papilla (p = 0.001) and a papilla hidden by a fold (p = 0.025).

Conclusions In our series, cannumaton of the papilla by standard techniques was performed in 70 % of cases. Predictors of failure were a small papilla, an eccentric papilla, and a papilla hidden by a fold.

Citation Nakhli A, Sabbah M, Bellil N etal. eP312 PREDICTORS OF FAILURE OF PAPILLA CANNULATION DURING ERCP FOR COMMON BILE DUCT STONES. Endoscopy 2021; 53: S200.

Publication History

Article published online:
19 March 2021