title: Success of ERCP at a referral center after a previously unsuccessful attempt.
abstract: BACKGROUND
  The diagnostic and therapeutic success of endoscopic retrograde cholangiopancreatography (ERCP) depends on a number of factors. When an attempt at ERCP fails, the physician must decide whether to repeat the procedure, rely on another imaging procedure (noninvasive or invasive), or refer to another endoscopist/center. Our aim in this prospective study was to determine the role of a second attempt at ERCP at a referral ERCP center.
  
  
  METHODS
  Five hundred sixty-two patients were referred for ERCP after having undergone a previous unsuccessful attempt to visualize the clinically relevant duct(s).
  
  
  RESULTS
  The overall success in visualizing the desired duct was 96.4% (542 of 562). Advanced techniques for cannulation were used in 41% (229 of 562). Anatomic abnormalities possibly contributing to the previous lack of success were present in 27% of cases. ERCP with or without manometry identified a cause or potential cause for the signs and symptoms in 86% of patients. Sixty complications occurred in 57 patients (10.1%). ERCP was unsuccessful in 20 patients (3.6%).
  
  
  CONCLUSIONS
  The cannulation success rate and diagnostic yield of further ERCP with an acceptable complication rate warrant consideration of referral to centers with available resources and expertise.
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202-5000, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Choudari
authors.forename: S
authors.initials: S
authors.lastname: Sherman
authors.forename: E L
authors.initials: EL
authors.lastname: Fogel
authors.forename: S
authors.initials: S
authors.lastname: Phillips
authors.forename: A
authors.initials: A
authors.lastname: Kochell
authors.forename: J
authors.initials: J
authors.lastname: Flueckiger
authors.forename: G A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D001660:Biliary Tract Diseases / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis*; D011446:Prospective Studies