Success Rate of Difficult Biliary Cannulation and Rescue Techniques During Endoscopic Retrograde Cholangiopancreatography at a Tertiary Level Referral Center

Successful deep cannulation of the common bile duct is the indispensable first step in endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to manage biliary disorders. The European Society of Gastrointestinal Endoscopy defines difficult biliary cannulation by prolonged or repeated attempts (>5 contacts or >5 minutes) or inadvertent pancreatic duct cannulation, and reports a deep biliary cannulation success rate of approximately 80%. Advanced cannulation techniques have substantially improved access while reducing the risk of adverse events such as bleeding, intestinal perforation, infection, and particularly post-ERCP pancreatitis. At this tertiary referral unit, the leading preprocedural diagnosis was choledocholithiasis (45.9%), followed by biliary stricture (39.3%). The most frequently used rescue technique was precut sphincterotomy in 98 patients (72.6%), followed by precut sphincterotomy plus interval ERCP (12.6%). Anatomical variations were present in 71.9% of cases. Biliary cannulation was successful in 105 cases (77.78%). The most frequent postprocedural diagnosis was choledocholithiasis (28.1%), followed by biliary stricture (27.4%). Bleeding occurred in 16 cases (12%), and papillary edema occurred in 1 case (1%). Among successfully cannulated patients, the most commonly used rescue technique was precut sphincterotomy (86.7%); among failed cannulations, precut sphincterotomy plus interval ERCP was the most frequent strategy (17 cases; 56.7%). Age and complication rates did not differ significantly between successful and failed cannulation groups (complications, p=0.1488).