title: Success of repeat ERCP by the same endoscopist.
abstract: BACKGROUND
  The success rate of repeat endoscopic retrograde cholangiopancreatography (ERCP) by the same endoscopist after a failed initial attempt is unknown. It has been suggested that a repeat examination at a tertiary referral center be performed after an unsuccessful attempt. Our aim was to determine the success rate of repeat ERCP at a different endoscopic session by the same endoscopist and the outcomes among patients with a failed index procedure.
  
  
  METHODS
  A review of 500 consecutive ERCP procedures was performed at a teaching institution.
  
  
  RESULTS
  The overall initial success rate for cannulation of the duct of interest was 90.8% at index endoscopy. Endoscopy was repeated after 51% unsuccessful procedures, and access to the desired duct was achieved in 87.5% of repeat attempts. A needle knife was used in 21% instances, and its use facilitated cannulation of the duct of interest in 80%. No complications occurred with repeat ERCP. Of the 3 patients who underwent failed repeated ERCP, 1 was not available for the follow-up study, 1 had metastatic cancer, and the other had pancreas divisum. The outcomes among patients who did not undergo repeat ERCP included malignant disease diagnosed with other imaging techniques (35% of patients) and no further admissions or emergency room visits for suspected pancreaticobiliary symptoms (39% of patients).
  
  
  CONCLUSIONS
  Repeat ERCP by the same endoscopist yields an 87.5% success rate. This leads to an overall success rate of 95%.
authors.affiliation: Department of Medicine, Gastroenterology Section, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, Arizona 85012, USA.
authors.forename: F C
authors.initials: FC
authors.lastname: Ramirez
authors.forename: B
authors.initials: B
authors.lastname: Dennert
authors.forename: R A
authors.initials: RA
authors.lastname: Sanowski
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis / Q000601:surgery*; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002404:Catheterization / Q000706:statistics & numerical data; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D016145:Endoscopy, Digestive System; D019160:Endosonography; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education; D006784:Hospitals, Teaching; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome