Causes and Countermeasures of Difficult Selective Biliary Cannulation: A Large Sample Size Retrospective Study

Area of Science:

• Gastroenterology
• Endoscopy
• Biliary Interventions

Background:

• Selective biliary cannulation is a critical yet challenging step in Endoscopic Retrograde Cholangiopancreatography (ERCP).
• Improving cannulation success rates and minimizing postoperative complications are key goals for endoscopists.

Purpose of the Study:

• To identify factors influencing difficult selective biliary cannulation.
• To evaluate the safety and effectiveness of various assistive cannulation techniques in ERCP.
• To provide practical guidance for endoscopists performing ERCP.

Main Methods:

• Retrospective review of ERCP database (January 2008 - December 2017).
• Analysis of first-time ERCP procedures, focusing on disease and anatomic factors.
• Statistical analysis (Pearson χ2 and Fisher exact tests) of difficult cannulation rates, success rates, and complication rates for 7 assistive techniques.

Main Results:

• The overall difficult cannulation rate was 8.1%.
• Key factors for difficult cannulation included biliary strictures, tumors, specific papilla characteristics, anomalous pancreaticobiliary junction, and Billroth II gastrectomy.
• While overall complication rates varied significantly (P<0.05), 7 assistive techniques showed no statistically significant differences in postoperative complication or overall cannulation success rates (P>0.05).
• Needle-knife precut sphincterotomy exhibited the highest complication rate.

Conclusions:

• Specific anatomical and pathological factors significantly increase the difficulty of selective biliary cannulation in ERCP.
• Despite variations in complication rates, various assistive techniques are generally safe and effective for selective biliary cannulation.
• Endoscopists should be aware of contributing factors to difficult cannulation and consider the complication profile of different assistive techniques, particularly needle-knife precut sphincterotomy.