title: Failed biliary cannulation: clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography.
abstract: OBJECTIVE
  Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center.
  
  
  METHODS
  Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP.
  
  
  RESULTS
  Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017).
  
  
  CONCLUSIONS
  Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.
authors.affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney 2145, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Swan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bourke
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Williams
authors.forename: Sina
authors.initials: S
authors.lastname: Alexander
authors.forename: Alan
authors.initials: A
authors.lastname: Moss
authors.forename: Rick
authors.initials: R
authors.lastname: Hope
authors.forename: David
authors.initials: D
authors.lastname: Ruppin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D011446:Prospective Studies; D012017:Referral and Consultation; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult