Effectiveness and safety of ERCP using the European Society of Gastrointestinal Endoscopy algorithm for biliary cannulation: a prospective study

Background: Biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) remains a critical yet challenging step, particularly in patients with a naïve papilla. The European Society of Gastrointestinal Endoscopy (ESGE) proposed a stepwise algorithm to guide cannulation strategies, but its real-world applicability and outcomes have not been systematically evaluated. This study aimed to assess the effectiveness and safety of ESGE algorithm-guided biliary cannulation during ERCP in a multicenter Italian cohort. Methods: This was a prospective observational study conducted across 11 Italian centers. Consecutive patients undergoing ERCP with naïve papilla were enrolled. Cannulation strategies were categorized based on adherence to the ESGE algorithm. Results: < 0.001). At multivariable analyses, factors significantly associated with successful cannulation were adherence to the ESGE algorithm, prone position, degree of ERCP difficulty, and use of short guidewire. Rates of post-ERCP pancreatitis were comparable overall, but moderate-to-severe pancreatitis and perforation were less frequent in the ESGE adherence group. Conclusions: Adherence to the ESGE cannulation algorithm was feasible and was associated with higher cannulation success during ERCP.

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Publication Details

Journal
Endoscopy
Published
2026-04-22
DOI
https://doi.org/10.1055/a-2825-9341
Primary Topic
Gallbladder and Bile Duct Disorders
Type
article
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article

Effectiveness and safety of ERCP using the European Society of Gastrointestinal Endoscopy algorithm for biliary cannulation: a prospective study

Giammarco Fava, Daniela Scimeca, C. Rosa, RD Mitri et al.
Endoscopy
Gallbladder and Bile Duct Disorders
article

Effectiveness and safety of ERCP using the European Society of Gastrointestinal Endoscopy algorithm for biliary cannulation: a prospective study

Giammarco Fava, Daniela Scimeca, C. Rosa, RD Mitri, Carlo Romano Settanni, P. Cantù, Niccolò Bina, N Olivari, Maurizio Zagari, Elton Dajti, A. Panarese, L. Benazzato, Helga Bertani, Silvia Cocca, Federico Iacopini, Francesco Maria Di Matteo, Cristina Grossi, Roberta Rea, Enrico Tettoni, Maurizio Azzurro, Livia Archibugi, Alberto Mariani, Paolo Giorgio Arcidiacono, Roberto Rosa, Costanza Alvisi
article en

Abstract

Background: Biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP) remains a critical yet challenging step, particularly in patients with a naïve papilla. The European Society of Gastrointestinal Endoscopy (ESGE) proposed a stepwise algorithm to guide cannulation strategies, but its real-world applicability and outcomes have not been systematically evaluated. This study aimed to assess the effectiveness and safety of ESGE algorithm-guided biliary cannulation during ERCP in a multicenter Italian cohort. Methods: This was a prospective observational study conducted across 11 Italian centers. Consecutive patients undergoing ERCP with naïve papilla were enrolled. Cannulation strategies were categorized based on adherence to the ESGE algorithm. Results: < 0.001). At multivariable analyses, factors significantly associated with successful cannulation were adherence to the ESGE algorithm, prone position, degree of ERCP difficulty, and use of short guidewire. Rates of post-ERCP pancreatitis were comparable overall, but moderate-to-severe pancreatitis and perforation were less frequent in the ESGE adherence group. Conclusions: Adherence to the ESGE cannulation algorithm was feasible and was associated with higher cannulation success during ERCP.

Endoscopy
Università Cattolica del Sacro Cuore (IT), Vita-Salute San Raffaele University (IT), University of Pavia (IT), Azienda Ospedaliero-Universitaria di Modena (IT), Istituto Nazionale di Fisica Nucleare, Sezione di Pavia (IT), Ospedale Koelliker (IT), Azienda USL di Bologna (IT), Azienda Ospedaliera S.Maria (IT), Fondazione Ospedale Salesi (IT), National Cancer Institute (UA), National Cancer Institute (MY), Campus Bio Medico University Hospital (IT), Azienda di Rilievo Nazionale ed Alta Specializzazione (IT), Fondazione Poliambulanza Istituto Ospedaliero (IT), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Azienda di Servizi alla Persona di Pavia (Italy) (IT), Ospedale Valduce (IT), Istituto Nazionale di Riposo e Cura per Anziani (IT), Lombardia Informatica (Italy) (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), National Cancer Research Institute (GB), University of Bologna (IT)
Openalex Percentile: Top 22%
Gallbladder and Bile Duct Disorders
DOISourceOpenAlex
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