Lidocaine Application for Cannulation in Endoscopic Retrograde Cholangiopancreatography

The primary challenge in endoscopic retrograde cholangiopancreatography (ERCP) is accessing the papilla.In this study, we aimed to assess the usefulness of applying 100 mg of 1% lidocaine to the major duodenal papilla during cannulation.A retrospective observational study was conducted with control and lidocaine-treated groups.To reduce bias, 48 cases from each group were matched using propensity scores.Papilla and oral protuberance morphologies were classified based on previous reports.The primary endpoint was deep bile duct intubation time.Secondary endpoints included bile duct intubation success rate, degree of papilla opening after lidocaine application, use of the pancreatic guidewire method, ERCP-related adverse events, and blood lidocaine levels.Factors influencing intubation time were analyzed using univariate and multivariate regression.The median intubation times were 52 and 240 seconds in the lidocaine and control groups, respectively (p<0.01).No significant differences were found between groups for disease, intubation success rate, use of the pancreatic guidewire technique, or post-procedural adverse events.Moderate papilla opening was observed in most patients (n=26) after lidocaine application.Three factors influencing intubation time were identified: pancreatic duct guidewire use, papilla pattern I, and oral protrusion pattern R. The study demonstrates that applying 100 mg of 1% lidocaine to the major papilla significantly reduced the time required for deep bile duct intubation, suggesting a potential new pre-treatment strategy for ERCP.