World Endoscopy Organization guidelines on endoscopic retrograde cholangiopancreatography biliary cannulation and sphincterotomy techniques
Recent guidelines on biliary cannulation are lacking. This guideline is an initiative of the World Endoscopy Organization (WEO) with the involvement of a panel of experts from Asia, Europe, and America. Relevant clinical questions on four areas (post-endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis [PEP] prophylaxis, biliary cannulation techniques, sphincterotomy/papillary balloon dilation, and biliary cannulation in special circumstances) were developed and answered after systematic reviews of the literature and using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Successful biliary cannulation and sphincterotomy are cornerstones of ERCP and are indispensable for almost all therapeutic and advanced diagnostic procedures. However, adverse events, particularly PEP, may commonly occur and impair patients' outcomes. A high cannulation rate and a low rate of PEP are quality indicators for ERCP and should be the goal of all endoscopists. With this guideline we aimed to provide clinical practice advice applicable worldwide, regardless of resources and expertise availability. The main recommendations focus on specific aspects of ERCP, including pre-, intra-, and postprocedural measures to reduce the risk of PEP, the technique for an initial biliary cannulation attempt, options for cannulation in cases of difficult biliary access, alternatives to ERCP in case of failure (percutaneous- and endoscopic ultrasound-guided), and biliary access in altered anatomy (periampullary diverticulum and postsurgical anatomy) and in the presence of duodenal stenosis.
Authors
- Stefano Francesco Crinò (ORCID: https://orcid.org/0000-0003-4560-8741)
- Eduardo Guimarães Hourneaux de Moura (ORCID: https://orcid.org/0000-0002-8023-3722)
- Ruveena Bhavani Rajaram (ORCID: https://orcid.org/0000-0002-3855-6536)
- Lars Aabakken (ORCID: https://orcid.org/0000-0002-3622-3826)
- Shannon Melissa Chan (ORCID: https://orcid.org/0000-0001-6280-4176)
- Fauze Maluf‐Filho (ORCID: https://orcid.org/0000-0001-8875-420X)
- Ryan J. Law (ORCID: https://orcid.org/0000-0001-7048-9268)
- Mostafa Ibrahim (ORCID: https://orcid.org/0000-0001-6019-5055)
- Do Hyun Park (ORCID: https://orcid.org/0000-0001-6275-3663)
- Anthony Yuen Bun Teoh (ORCID: https://orcid.org/0000-0002-1885-8035)
- Parit Mekaroonkamol (ORCID: https://orcid.org/0000-0002-3206-3431)
- Dong Wan Seo (ORCID: https://orcid.org/0000-0003-4971-834X)
- D. Nageshwar Reddy
- Amol Bapaye (ORCID: https://orcid.org/0000-0001-7632-814X)
- Rapat Pittayanon (ORCID: https://orcid.org/0000-0001-6407-5245)
- Mitsuhiro Kida
- Alexandre Bestetti
Institutions
- Ulsan College (KR)
- Oslo University Hospital (NO)
- University Malaya Medical Centre (MY)
- Mayo Clinic (US)
- Chulalongkorn University (TH)
- Chinese University of Hong Kong (HK)
- Universidade de São Paulo (BR)
- University of Oslo (NO)
- King Chulalongkorn Memorial Hospital (TH)
- WinnMed (US)
- University of Malaya (MY)
- University of Ulsan (KR)
- Instituto do Câncer do Estado de São Paulo (BR)
- Hong Kong Sanatorium and Hospital (HK)
- Kitasato University Hospital (JP)
- Prince of Wales Hospital (CN)
- Deenanath Mangeshkar Hospital and Research Center (IN)
- Asian Institute of Gastroenterology (IN)
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (BR)
- Pancreas Centre (Canada) (CA)
- Theodor Bilharz Research Institute (EG)
Publication Details
- Journal
- Digestive Endoscopy
- Published
- 2025-06-16
- DOI
- https://doi.org/10.1111/den.15060
- Citations
- 5
- Primary Topic
- Gallbladder and Bile Duct Disorders
- Type
- article
- Field-Weighted Citation Impact
- 7.59