Second endoscopic retrograde cholangiopancreatography after failure of initial biliary cannulation: A single institution retrospective experience

Abstract

Endoscopic retrograde cholangiopancreatography (ERCP) is not always successful when difficult biliary cannulation occurs. A second ERCP seems to be a worthwhile option following initial failure cannulation; however, relevant data are limited. Thus, the aim of the present study was to determine the outcomes of repeating ERCP in patients in whom the first biliary cannulation with or without precut sphincterotomy failed. It retrospectively analyzed 4,136 patients who underwent an initial biliary access between June 2016 and September 2020. Data from our databases were analyzed. Efficacy was based on the cannulation rate of the second ERCP and safety was assessed in terms of adverse events. Of 94 patients, 56 (59.6%) underwent a second ERCP and the success rate in biliary cannulation was 83.9% (47 of 56). The median operative time in the second ERCP was shorter than that in the initial procedure (47 vs. 65 min, P<0.001). A total of 5 patients (8.9%) suffered from mild ERCP-associated complications following the second ERCP. Compared with patients that did not undergo a second ERCP, patients that underwent a second ERCP had a lower 30-day mortality rate (13.2 vs. 1.8%, P=0.038). In addition, by univariate and multivariate analysis, it was observed that normal preoperative serum bilirubin levels and an interval time of <3 days were correlated with the cannulation failure of a second ERCP (OR=9.211, P=0.019, OR=6.765, P=0.041, respectively). A second ERCP following failure of an initial biliary cannulation appears to be safe and effective. For most clinically stable patients with an unsuccessful initial ERCP, a second ERCP after 2-4 days may be an optimal strategy. Preoperative normal serum bilirubin levels may be a risk factor that can be used for predicting cannulation failure of a second ERCP procedure.

Analysis of the Effectiveness of Second Attempt Endoscopic Retrograde Cholangiopancreatography (ERCP) 24 Hours (Second Day) After Primary Failure

“…The majority of pancreaticobiliary disorders are now diagnosed and treated with ERCP, which is a minimally invasive procedure. Studies have shown that experienced endoscopists using a needle-knife have improved the cannulation success rate to between 85% and 99%; however, the matter of selecting the best substitute among the available options in the event of initial ERCP failure still holds interest [1,11]. A subsequent ERCP within a few days is an effective and safe therapy for patients who are clinically stable, with a success rate of 68%-79% [2,12,13].…”

“…Endoscopic retrograde cholangiopancreatography (ERCP) is a minimally invasive intervention that has established itself as the gold standard therapeutic option for various pancreaticobiliary conditions [1]. Nonetheless, there are times when ERCP is ineffective, even when performed by highly trained professionals or at major healthcare institutions [2].…”

Enlarged fistulotomy of the papilla as access to the biliary tract during ERCP

“…According to Flumignan [ 18 ] and Deng [ 19 ], a second fistulotomy attempt is feasible, and safe, and can be attempted after a short 48-hour interval if the first ERCP attempt is unsuccessful.…”

Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II endoscopic retrograde cholangiopancreatography-related perforations

“…There must be a golden time for a second ERCP, as the perforation will progressively increase inflammation in the periampullary region. A second ERCP is defined as a safe procedure 2–4 days after failure of the first biliary cannulation [ 19 , 20 ]. Since type 2 perforations already have sphincterotomy, cannulation is not difficult in very early period.…”