Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers
Por:
Colan-Hernandez, J, Aldana, A, Concepcion, M, Chavez, K, Gomez, C, Mendez-bocanegra, A, Martinez-Guillen, M, Sendino, O, Villanueva, C, Llach, J, Guarner-Argente, C, Cardenas, A, Guarner, C
Publicada:
1 sep 2017
Resumen:
Precut sphincterotomy increases the success of deep biliary cannulation, but the method fails at the initial ERCP in 5-12% of cases. Although other invasive strategies are often used to access the bile duct, a second ERCP may be effective and safe. We evaluated the efficacy, safety, and factors related to a second ERCP after failed cannulation using a precut sphincterotomy.
We reviewed all patients that underwent an ERCP with native papilla from 2006 to 2014 at two tertiary institutions. Efficacy was based on the cannulation rate of the second ERCP, and safety was assessed in terms of adverse events.
We identified 112 patients with failed cannulation after precut, and a second ERCP was performed in 72 (64.3%). Median time between procedures was 7 days (IQR 5-11). Deep cannulation was achieved in 54 cases (75%). The only factor associated with cannulation failure was an ERCP within 4 days after the initial precut (cannulation success 44.4 vs. 79.4% after 4 days, p = 0.026). Adverse events were recorded after the first ERCP in 13 of 112 patients (11.8%): delayed bleeding in four, pancreatitis in five, and perforation in four. After the second ERCP, three of 72 patients (4.2%) presented adverse events: two delayed bleeding and one pancreatitis.
A second ERCP after failure of initial biliary cannulation following precut appears to be safe and effective. A second ERCP should be delayed at least 4 days if feasible.
Filiaciones:
Colan-Hernandez, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
Aldana, A:
Univ Barcelona, Hosp Clin, Barcelona, Spain
Concepcion, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
Chavez, K:
Univ Barcelona, Hosp Clin, Barcelona, Spain
Gomez, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
Mendez-bocanegra, A:
Univ Barcelona, Hosp Clin, Barcelona, Spain
Martinez-Guillen, M:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
Sendino, O:
Univ Barcelona, Hosp Clin, Barcelona, Spain
Villanueva, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
CIBEREHD, Barcelona, Spain
Llach, J:
Univ Barcelona, Hosp Clin, Barcelona, Spain
Guarner-Argente, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
Cardenas, A:
Univ Barcelona, Hosp Clin, Barcelona, Spain
Guarner, C:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Serv Patol Digest, C San Quinti 89, Barcelona 08041, Spain
CIBEREHD, Barcelona, Spain
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