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Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs

Halttunen, Jorma ; Meisner, Soren ; Aabakken, Lars ; Arnelo, Urban ; Gronroos, Juha ; Hauge, Truls ; Kleveland, Per M. ; Schmidt, Palle Nordblad ; Saarela, Arto and Swahn, Fredrik , et al. (2014) In Scandinavian Journal of Gastroenterology 49(6). p.752-758
Abstract
Background. The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). Aims. To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. Patients and methods. Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. Results. The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and... (More)
Background. The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). Aims. To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. Patients and methods. Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. Results. The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and post-ERCP pancreatitis (PEP) rate was 5.3%. The median time for all successful cannulations was 1.55 min (range 0.02-94.2). If the primary cannulation succeeded, the pancreatitis rate was 2.8%; after secondary methods, it rose to 11.5%. Procedures lasting less than 5 min had a PEP rate of 2.6% versus 11.8% in those lasting longer. With one attempt, the PEP rate was 0.6%, with two 3.1%, with three to four 6.1%, and with five and more 11.9%. With one accidental pancreatic guide-wire passage, the risk of the PEP was 3.7%, and with two passages, it was 13.1%. Conclusions. If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded. (Less)
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cannulation, ERCP, needle knife, sphincterotomy
in
Scandinavian Journal of Gastroenterology
volume
49
issue
6
pages
752 - 758
publisher
Informa Healthcare
external identifiers
  • wos:000336387200012
  • scopus:84901497674
  • pmid:24628493
ISSN
1502-7708
DOI
10.3109/00365521.2014.894120
language
English
LU publication?
yes
id
e0ab0e2e-6ed3-463d-ad2e-1a0bf6e45b83 (old id 4559028)
date added to LUP
2016-04-01 12:57:31
date last changed
2025-04-04 14:45:35
@article{e0ab0e2e-6ed3-463d-ad2e-1a0bf6e45b83,
  abstract     = {{Background. The definition of a "difficult" cannulation varies considerably in reports of endoscopic retrograde cholangiopancreatography (ERCP). Aims. To define a difficult cannulation, which translates into higher risk of post-ERCP pancreatitis. Patients and methods. Prospective consecutive recording of 907 cannulations in Scandinavian centers done by experienced endoscopists. Inclusion: indication for biliary access in patients with intact papilla. Exclusion: acute non-biliary and chronic pancreatitis at time of procedure. Results. The primary cannulation succeeded in 74.9%, with median values for time 0.88 min (53 s), with two attempts and with zero pancreatic passages or injections. The overall cannulation success was 97.4% and post-ERCP pancreatitis (PEP) rate was 5.3%. The median time for all successful cannulations was 1.55 min (range 0.02-94.2). If the primary cannulation succeeded, the pancreatitis rate was 2.8%; after secondary methods, it rose to 11.5%. Procedures lasting less than 5 min had a PEP rate of 2.6% versus 11.8% in those lasting longer. With one attempt, the PEP rate was 0.6%, with two 3.1%, with three to four 6.1%, and with five and more 11.9%. With one accidental pancreatic guide-wire passage, the risk of the PEP was 3.7%, and with two passages, it was 13.1%. Conclusions. If the increasing rate of PEP is taken as defining factor, the wire-guided cannulation of a native papilla can be considered difficult after 5 min, five attempts, and two pancreatic guide-wire passages when any of those limits is exceeded.}},
  author       = {{Halttunen, Jorma and Meisner, Soren and Aabakken, Lars and Arnelo, Urban and Gronroos, Juha and Hauge, Truls and Kleveland, Per M. and Schmidt, Palle Nordblad and Saarela, Arto and Swahn, Fredrik and Toth, Ervin and Mustonen, Harri and Lohr, J. -Matthias}},
  issn         = {{1502-7708}},
  keywords     = {{cannulation; ERCP; needle knife; sphincterotomy}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{752--758}},
  publisher    = {{Informa Healthcare}},
  series       = {{Scandinavian Journal of Gastroenterology}},
  title        = {{Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs}},
  url          = {{http://dx.doi.org/10.3109/00365521.2014.894120}},
  doi          = {{10.3109/00365521.2014.894120}},
  volume       = {{49}},
  year         = {{2014}},
}