Abstract
Overcoming Difficult Biliary Cannulations: A Trainee’s Perspective
Ben Joseph P. Rodriguez, MD
Selective cannulation of the common bile duct (CBD) is a prerequisite in performing endoscopic retrograde cholangiopancreatoscopy (ERCP). However, difficult biliary cannulation may occur in a significant proportion of patients. We aim to identify effective modalities in achieving deep biliary cannulation in difficult cases while determining the rate of immediate procedure-related complications, and to assess the competence of an ERCP trainee in dealing with difficult biliary cannulation over the course of training.
Methodology: This is a single-center, retrospective, analytical, cross-sectional study involving ERCP patients with native papilla from February 2022 to December 2022 handled by the ERCP trainee. There were 67 difficult biliary cannulation cases fulfilling the European Society of Gastrointestinal Endoscopy (ESGE) criteria. Outcomes measured were cannulation success rate, the modality used, and procedure-related complication rate. Chi-square test was used to determine improvement in trainee performance with biliary cannulation. Stata 13 (Stata Corp., College Park, Texas, USA) was used to analyze the data.
Results: Successful cannulation of the papilla was achieved in 58/67 (86.6%) patients fulfilling the ESGE criteria. Wire-guided sphincterotome was used to achieve deep biliary cannulation in 29 (50%) patients, while 10 (17.2%) with a regular biliary catheter. Double guidewire technique was employed in 14 (24.1%), rendezvous technique in 4 (6.9%) and needle-knife access in 1(1.7%). Immediate complications occurred in 13 (19.4%) patients, particularly pancreatitis (7; 10.4%) and bleeding (6; 9%). Over the course of training, there was a significant improvement in the trainee’s performance with regard to success in difficult biliary cannulation (P=0.003; 95% CI).
Keywords: ERCP, difficult biliary cannulation, ERCP training, complications, post-ERCP pancreatitis
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |