title: Repeat endoscopic retrograde cholangiopancreaticography after failed initial precut sphincterotomy for biliary cannulation.
abstract: OBJECTIVE
  To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation.
  
  
  METHODS
  In this retrospective study, consecutive ERCPs performed between January 2009 and September 2012 were included. Data from our endoscopy and radiology reporting databases were analysed for use of precut sphincterotomy, biliary access rate, repeat ERCP rate and complications. Patients with initially failed precut sphincterotomy were identified.
  
  
  RESULTS
  From 1839 consecutive ERCPs, 187 (10%) patients underwent a precut sphincterotomy during the initial ERCP in attempts to cannulate a native papilla. The initial precut was successful in 79/187 (42%). ERCP was repeated in 89/108 (82%) of patients with failed initial precut sphincterotomy after a median interval of 4 d, leading to successful biliary cannulation in 69/89 (78%). In 5 patients a third ERCP was attempted (successful in 4 cases). Overall, repeat ERCP after failed precut at the index ERCP was successful in 73/89 patients (82%). Complications after precut-sphincterotomy were observed in 32/187 (17%) patients including pancreatitis (13%), retroperitoneal perforations (1%), biliary sepsis (0.5%) and haemorrhage (3%).
  
  
  CONCLUSIONS
  The high success rate of biliary cannulation in a second attempt ERCP justifies repeating ERCP within 2-7 d after unsuccessful precut sphincterotomy before more invasive approaches should be considered.
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Pavlides
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Ashley
authors.initials: A
authors.lastname: Barnabas
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Fernandopulle
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Adam A
authors.initials: AA
authors.lastname: Bailey
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Collier
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Phillips-Hughes
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Ellis
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Roger
authors.initials: R
authors.lastname: Chapman
authors.affiliation: Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
authors.forename: Barbara
authors.initials: B
authors.lastname: Braden
mesh_terms: D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000401:mortality; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure
keywords: Choledocholithiasis; Endoscopic retrograde cholangio-pancreaticography; Mortality; Post-endoscopic retrograde cholangio-pancreaticography pancreatitis; Precut sphincterotomy