EVALUATION OF ADVANCED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) TECHNIQUES FOR SELECTIVE BILIARY CANNULATION

Aims Selective biliary cannulation (SBC) by standard methods (SM) in endoscopic retrograde cholangiopancreatography (ERCP) can be unsuccessful in up to 20% of patients. When SM of SBC fail, a variety of advanced cannulation techniques (ACT) are available. The aim of the study was to evaluate the effectiveness, security and predisposing factors of ACT

Methods Retrospective study of an ERCP prospective collected database in patients without previous sphincterotomy in 2015-2019. Demographic, clinical and endoscopic data were analysed to compare ACT and SM. Factors associated with need of ACT were identified using a univariate-multivariate regression analysis

Results Out of 1031 patients, SM were performed in 778 (75.5%) with the remaining 253 (24.5%) undergoing ACT. Five different ACT were performed: precut (39.1%), double guidewire technique (30.8%), pancreatic stent (15.8%), precut after pancreatic stent insertion (11.1%) and transpancreatic precut sphincterotomy (3.2%). SBC success rates were 73.1% with SM (754/1031) and, after SM failure, 87% (220/253) with ACT. Globally, SBC success rate was 94.5% (974/1031). Malignant neoplasia as indication of ERCP was associated with need of ACT in multivariate regression analysis (adjusted OR 3.17; CI 95% (2.21-4.56), p< 0.001). Complication rate was higher with ACT than with SM (19% vs 7.5%, respectively) (p< 0.001), due to an increased rate in ACT group of pancreatitis (12.3% vs 3.3%, respectively) (p< 0.0001) and bleeding (4.3% vs 1.8%, respectively) (p< 0.02). However, there were no differences between complication rates of ACT (19%) and the subgroup of SM in which more than 10 attempts of SBC were tried (20%) (p=0.28)

Conclusions

1. Through ACT a high rate of successful SCB after SM failure can be achieved, although they are associated with an increased complication risk

2. There are no significant difference in adverse events between ACT and SM with>10 attempts of SBC

3. Indication of ERCP due to malignancy predicts the need of resorting to ACT