Can failure of choledochal cannulation in endoscopic retrograde cholangiopancreatography be prevented?

Abstract

Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently used in the diagnosis and treatment of hepatic, biliary and pancreatic diseases. Failure during cannulation, however, requires other interventions. The purpose of this work is to create the parameters that can be used to predict failure during ERCP.
Methods: Case control study planned. ERCP procedures between December 2016 and February 2018 were evaluated. Duplicate attempts and causes, cannulation status were recorded and the factors affecting cannulation were examined. Descriptive analyzes were used for statistical evaluation, chi-square test for categorical data and t-test for continuous data. A p value of 0.05 or less was considered statistically significant in the analysis.
Results: A total of 458 ERCP procedures were performed in 288 patients during the study period. 159 of the patients were female, 129 were male, female / male ratio was 1.2, mean age was 59±17.9 and age range was 17-105. When ERCP indications were evaluated, 258 patients (89.6%) were treated due to choledocholithiasis. In the first procedure, selective choledochal cannulation was successful in 257 (89.3%) patients (229 patients with ERCP catheter and 28 patients with assisted methods), and these patients constituted study group. The remaining patients who cannulation was failed included in control group. There were no age and gender differences in the patients who failed cannulation (p: 0.270, 0.256, respectively). In failed cases, the duodenal diverticulum and pancreas head tumor were seen. In the first operation, 264 patients, mainly choledocholithiasis (n: 214), could be diagnosed.
Conclusion: It has been shown that the gender and age of the patient and structural differences such as the duodenal diverticulum do not affect the success of cannulation during ERCP. Upper abdominal operations like Billroth II and Roux-en-Y gastrojejunostomy reduce the success rate of cannulation. It is thought that the correlation between experience level of endoscopist and cannulation success.