title: How to cannulate? A survey of the Scandinavian Association for Digestive Endoscopy (SADE) in 141 endoscopists.
abstract: Cannulation of the papilla vateri represents an enigmatic first step in endoscopic retrograde cholangiopancreaticography (ERCP). In light of falling numbers of (diagnostic) ERCP and novel techniques, e.g. short-wire system, we were interested in the approach novice and experienced endoscopist are taking; especially, what makes a papilla difficult to cannulate and how to approach this. We devised a structured online questionnaire, sent to all endoscopists registered with SADE, the Scandinavian Association for Digestive Endoscopy. A total of 141 responded. Of those, 49 were experienced ERCP-endoscopists (>900 ERCPs). The first choice of cannulation is with a sphincterotome and a preinserted wire. Both less experienced and more experienced endoscopists agreed on the criteria to describe a papilla difficult to cannulate and both would choose the needle-knife sphincterotomy (NKS) to get access to the bile duct. The less experienced used more "upward" NKS, whereas the more experienced also used the "downward" NKS technique. This survey provides us with a database allowing now for a more differentiated view on cannulation techniques, success, and outcome in terms of pancreatitis.
authors.affiliation: Gastrocentrum Kirurgi, Karolinska Universitetssjukhuset, Stockholm, Sweden. matthias.lohr@ki.se
authors.forename: J-Matthias
authors.initials: JM
authors.lastname: Löhr
authors.forename: Lars
authors.initials: L
authors.lastname: Aabakken
authors.forename: Lars
authors.initials: L
authors.lastname: Aabaken
authors.forename: Urban
authors.initials: U
authors.lastname: Arnelo
authors.forename: Juha
authors.initials: J
authors.lastname: Grönroos
authors.forename: Jorma
authors.initials: J
authors.lastname: Halttunen
authors.forename: Truls
authors.initials: T
authors.lastname: Hauge
authors.forename: Eduard
authors.initials: E
authors.lastname: Jonas
authors.forename: Per M
authors.initials: PM
authors.lastname: Kleveland
authors.forename: Palle
authors.initials: P
authors.lastname: Nordblad Schmidt
authors.forename: Fredrik
authors.initials: F
authors.lastname: Swahn
authors.forename: Arto
authors.initials: A
authors.lastname: Saarela
authors.forename: Ervin
authors.initials: E
authors.lastname: Toth
authors.forename: Søren
authors.initials: S
authors.lastname: Meisner
mesh_terms: D001652:Bile Ducts; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D005762:Gastroenterology; D006801:Humans; D010818:Practice Patterns, Physicians'; D012537:Scandinavian and Nordic Countries; D011795:Surveys and Questionnaires