Feasibility of the novel 3-step protocol for biliary cannulation--a prospective analysis

Area of Science:

• Gastroenterology
• Endoscopy
• Biliary Interventions

Background:

• Deep biliary cannulation is crucial for endoscopic retrograde cholangiopancreatography (ERCP) procedures.
• The traditional 2-step protocol has limitations in achieving successful biliary access.
• Novel techniques are being explored to improve cannulation success rates and patient safety.

Purpose of the Study:

• To evaluate the feasibility and safety of a novel sequential 3-step protocol for deep biliary cannulation.
• To compare the efficacy of the traditional cannula with guidewire, double-guidewire, and needle-knife techniques within the 3-step protocol.

Main Methods:

• A prospective study included 105 consecutive patients undergoing ERCP with intended biliary cannulation.
• The sequential 3-step protocol involved: 1) traditional cannula with guidewire, 2) double-guidewire technique, and 3) needle-knife technique.
• Data on cannulation success, time, and post-ERCP complications were recorded.

Main Results:

• The overall success rate for deep biliary cannulation was 99% (104/105).
• The sequential 3-step protocol demonstrated high efficacy, with the needle-knife technique achieving 100% success in applied cases.
• The rate of post-ERCP pancreatitis was 3% and post-ERCP cholangitis was 2%, indicating an acceptable complication profile.

Conclusions:

• The novel sequential 3-step protocol is an effective and safe method for deep biliary cannulation in experienced hands.
• This protocol offers a high success rate (99%) for achieving biliary access during ERCP.
• The low complication rates suggest the protocol is well-tolerated by patients.