A SECOND ATTEMPT OF CBD CANNULATION AFTER ERCP FAILURE: A SYSTEMATIC REVIEW AND POOLED ANALYSIS

Aims ERCP initially fails in 10% to 20% of patients of difficult anatomy/inability to cannulate the papilla. In such instances, the indication for repeating biliary intervention should be carefully reconsidered. We assess the efficacy and safety of the second attempt after first ERCP failure.

Methods we searched multiple databases(Embase, PUBMED; Cochrane) to identify 9 studies for a total of 540 patients, reporting the efficacy and safety of a second attempt of ERCP after first failure. Outcomes were clinical success, adverse events. Pooled analysis wa sperformed using a proportion with Medcalc software

Results Second attempt had succcessfull cannulation rate of 84.79% (PR) (95%CI 81.5–87.7) with significant heterogeneity I2 81%, and a pooled rate of adverse events of 5% (PR) 95%CI 2.42–8.6%).

Conclusions According to our results second attempt is an effective and safe treatment in case of cannulation failure. However, we should be taking account the endoscopist expertise and case volume. Further studies are needed to define the role of second attempt in case of difficult cannulation