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Related Concept Videos

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Updated: Nov 3, 2025

Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
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Difficult biliary cannulation in ERCP procedures with or without trainee involvement: a comparative study.

Xu Wang1, Hui Luo1, Qin Tao1

  • 1State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China.

Endoscopy
|June 4, 2021
PubMed
Summary
This summary is machine-generated.

New 15-10-2 criteria for difficult biliary cannulation are proposed for trainee-involved procedures, differing from the 5-5-1 guidelines. These criteria aim to better define challenging cases during training, ensuring appropriate management and outcomes.

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Area of Science:

  • Gastroenterology
  • Endoscopic Procedures
  • Medical Education

Background:

  • The European Society of Gastrointestinal Endoscopy proposed the 5-5-1 criteria to define difficult biliary cannulation.
  • These criteria may not accurately reflect the challenges encountered in procedures involving trainees.
  • This study aimed to develop and validate new criteria for difficult biliary cannulation in trainee-involved settings.

Purpose of the Study:

  • To develop and validate new criteria for defining difficult biliary cannulation specifically for procedures involving trainees.
  • To compare the efficacy of proposed trainee-involved criteria with existing guidelines.

Main Methods:

  • A propensity score matching (PSM) analysis was conducted on patients undergoing biliary cannulation, with or without trainee involvement.
  • Difficult cannulation was defined by exceeding the 75th percentile for cannulation time, attempts, or inadvertent pancreatic duct (PD) cannulation.
  • Exclusion criteria included procedures that were potentially too simple or too complex (e.g., fistula, altered anatomy).

Main Results:

  • After PSM, trainee-involved procedures showed significantly longer cannulation times (median 7.5 min vs. 2.0 min), more attempts (median 5 vs. 2), and more inadvertent PD cannulations compared to non-trainee procedures (P < 0.001).
  • The proposed 15-10-2 criteria were developed for trainee-involved cannulation, while the 5-5-1 criteria were nearly confirmed for non-trainee procedures.
  • The incidence of difficult cannulation was 35.5% for trainee-involved procedures (15-10-2 criteria) and 31.8% for non-trainee procedures (5-5-1 criteria).

Conclusions:

  • The proposed 15-10-2 criteria, utilizing the 75th percentile cutoffs, appear appropriate for defining difficult biliary cannulation in trainee-involved procedures.
  • The 5-5-1 criteria were nearly confirmed for procedures without trainee involvement.
  • Incidences of post-ERCP pancreatitis were comparable between difficult cannulation groups defined by the respective criteria.