Endoscopy 2019; 51(04): S76-S77
DOI: 10.1055/s-0039-1681395
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: ERCP cannulation 1 Panorama Hall
Georg Thieme Verlag KG Stuttgart · New York

ANALYSIS OF BILIARY CANNULATION ALGORITHM IN HIGH-VOLUME HUNGARIAN ERCP CENTERS BASED ON PROSPECTIVELY COLLECTED REGISTRY DATA

D Pécsi
1   University of Pécs, Medical School, Institute for Translational Medicine, Pécs, Hungary
,
S Gódi
2   University of Pécs, Medical School, Division of Gastroenterology, First Department of Medicine, Pécs, Hungary
,
P Hegyi
1   University of Pécs, Medical School, Institute for Translational Medicine, Pécs, Hungary
,
I Altorjay
3   University of Debrecen, Division of Gastroenterology, Second Department of Medicine, Debrecen, Hungary
,
T Bakucz
4   Medical Centre, Hungarian Defence Forces, Department of Gastroenterology, Budapest, Hungary
,
L Czakó
5   University of Szeged, First Department of Medicine, Szeged, Hungary
,
G Kovács
3   University of Debrecen, Division of Gastroenterology, Second Department of Medicine, Debrecen, Hungary
,
Á Orbán-Szilágyi
4   Medical Centre, Hungarian Defence Forces, Department of Gastroenterology, Budapest, Hungary
,
F Pakodi
2   University of Pécs, Medical School, Division of Gastroenterology, First Department of Medicine, Pécs, Hungary
,
Á Patai
6   Markusovszky Teaching Hospital, Department of Gastroenterology, Szombathely, Hungary
,
Z Szepes
5   University of Szeged, First Department of Medicine, Szeged, Hungary
,
T Gyökeres
4   Medical Centre, Hungarian Defence Forces, Department of Gastroenterology, Budapest, Hungary
,
Á Vincze
2   University of Pécs, Medical School, Division of Gastroenterology, First Department of Medicine, Pécs, Hungary
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Selective biliary duct cannulation (BDC) was analysed in our current practice based on the data from five tertiary centers according to the recent evidence-based ESGE algorithm of biliary access.

Methods:

The prospectively collected ERCP Registry contained 1011 cases of intact papilla with biliary indications. The rate of difficult biliary access and the usage of advanced biliary cannulation methods were analysed.

Results:

Simple cannulation (659 cases, 65.2%): Deep BDC was achieved with guidewire in 305 cases (30.2%), with papillotome in 312 cases (30.9%), but failed in 39 cases (3.9%) due to anatomical obstacles. In 3 (0.3%) cases the BDC was not successful. The average cannulation time was 125 s, only 6.1% of the patient had longer than 300 s cannulation time. Twelve (1.9%) post-ERCP pancreatitis (PEP) occurred. Pancreatic guidewire (PGW) assisted cannulation (134 cases, 13.3%): BDC was achieved with double guidewire in 27, with papillotome in 3, while after prophylactic pancreas stent (PPS) insertion in 12 cases. Pre-cutting was used after PGW or PPS insertion in 12 and 33 cases, TPS was performed in 47 cases. The average cannulation time was 481 s. Biliary access failed in 18 patients (13.4%), while PEP rate was 2.2%. Needle-knife precut (NKP) (160 patients, 15.8%): BDC failed in 28 (17.5%), while PEP developed in 7 cases (4.4%). The average cannulation time was 514 s. Needle-knife fistulotomy (NKF) (58 patients, 5.7%): BDC failed in 4 (6.9%), PEP developed in 2 cases (3.4%). The average cannulation time was 466 s. The overall failure rate of BDC in our cohort was 5.2% (53/1011) excluding anatomical reasons. 42 out of 44 initially failed procedures were successfully completed later on.

Conclusions:

Advanced biliary cannulation methods were used in our tertiary centers in more than one third of the cases. NKF had the highest BDC rate and required the shortest cannulation time. The PEP rates were similar in the different groups.