Determination of the success rate of repeated attempt ERCP by the same endoscopist

Research output: Contribution to journalArticle

Abstract

Failure rates for cannulating the desired duct at ERCP vary from 5% to 15%. A first failed attempt may lead to a repeated study if clinically indicated, or otherwise to clinical follow up or an alternative diagnostic test. The success rate of a repeat ERCP in the hands of the same endoscopist is unknown. Objectives: To determine 1) the success rate of a repeat attempt at ERCP by the same operator and 2) the outcome of those patients with initially failed ERCP and non-repeated study. Material and Methods: Five-hundred consecutive ERCPs performed by or under the direct supervision of a single staff gastroenterologist at a VA Medical Center were reviewed. Results: A failed cannulation of the duct of interest at the initial ERCP occurred in 9.4% of cases (47 ERCPs). Eight (17%) of these, had BII anastomosis. The initially failed ducts were: CBD in 34 cases (72.3%). PD in 10 (21.2%), both ducts in 2 (4.2%) and the duct of Santorini in I (2.1%) Indications for patients in which the first attempt failed were: Jaundice (19.1%), Abnormal imaging study (US/CT) (23.4%). Pancreatitis (18%). Elevated alkaline phosphatase and stent placement (8%, each). Abdominal pain (6%), and Others (16%). ERCP was repeated by or under the same endoscopist's supervision in 24 cases (51%), in a median of 16 days later (Range:1 day to 2 years). The initially failed duct was successfully opacified/cannulated at the repeated attempt in 21 (87.5%) of these cases. A needle knife sphincterotomy was used in 5 cases (21%) and allowed the successful cannulation of the desired duct in 80% of them Of the 23 patients with initially failed cannulation and no repeated study, the final diagnosis were Cancer with/without liver metastasis in 8: cholecystectomy with normal intraoperative cholangiogram (IOC) in 2: AIDS in 2; no returned visits for symptoms or abnormal tests in 9; alcoholic pancreatitis in I and, death from sepsis in 1. Diagnosis of those with a failed repeated attempt. 1 cancer with liver metastasis; 1 cholecystectomy for cholelithiasis (normal IOC), and 1 has lost follow up. Conclusions: 1) The success rate of a repeated ERCP for the same endoscopist was 87.5%. 2) The clinical outcome of those with failed ERCP and a non-repeated attempt was dictated by the final diagnosis which was reached by other means.

Original languageEnglish (US)
Pages (from-to)379
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996
Externally publishedYes

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Endoscopic Retrograde Cholangiopancreatography
Catheterization
Cholecystectomy
Alcoholic Pancreatitis
Neoplasm Metastasis
Cholelithiasis
Pancreatic Ducts
Liver Neoplasms
Jaundice
Routine Diagnostic Tests
Pancreatitis
Abdominal Pain
Needles
Stents
Alkaline Phosphatase
Sepsis
Acquired Immunodeficiency Syndrome

ASJC Scopus subject areas

  • Gastroenterology

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Determination of the success rate of repeated attempt ERCP by the same endoscopist. / Dennert, B.; Ramirez, Francisco C.

In: Gastrointestinal Endoscopy, Vol. 43, No. 4, 1996, p. 379.

Research output: Contribution to journalArticle

@article{732d9414399e42b7b6639f9fbe74711b,
title = "Determination of the success rate of repeated attempt ERCP by the same endoscopist",
abstract = "Failure rates for cannulating the desired duct at ERCP vary from 5{\%} to 15{\%}. A first failed attempt may lead to a repeated study if clinically indicated, or otherwise to clinical follow up or an alternative diagnostic test. The success rate of a repeat ERCP in the hands of the same endoscopist is unknown. Objectives: To determine 1) the success rate of a repeat attempt at ERCP by the same operator and 2) the outcome of those patients with initially failed ERCP and non-repeated study. Material and Methods: Five-hundred consecutive ERCPs performed by or under the direct supervision of a single staff gastroenterologist at a VA Medical Center were reviewed. Results: A failed cannulation of the duct of interest at the initial ERCP occurred in 9.4{\%} of cases (47 ERCPs). Eight (17{\%}) of these, had BII anastomosis. The initially failed ducts were: CBD in 34 cases (72.3{\%}). PD in 10 (21.2{\%}), both ducts in 2 (4.2{\%}) and the duct of Santorini in I (2.1{\%}) Indications for patients in which the first attempt failed were: Jaundice (19.1{\%}), Abnormal imaging study (US/CT) (23.4{\%}). Pancreatitis (18{\%}). Elevated alkaline phosphatase and stent placement (8{\%}, each). Abdominal pain (6{\%}), and Others (16{\%}). ERCP was repeated by or under the same endoscopist's supervision in 24 cases (51{\%}), in a median of 16 days later (Range:1 day to 2 years). The initially failed duct was successfully opacified/cannulated at the repeated attempt in 21 (87.5{\%}) of these cases. A needle knife sphincterotomy was used in 5 cases (21{\%}) and allowed the successful cannulation of the desired duct in 80{\%} of them Of the 23 patients with initially failed cannulation and no repeated study, the final diagnosis were Cancer with/without liver metastasis in 8: cholecystectomy with normal intraoperative cholangiogram (IOC) in 2: AIDS in 2; no returned visits for symptoms or abnormal tests in 9; alcoholic pancreatitis in I and, death from sepsis in 1. Diagnosis of those with a failed repeated attempt. 1 cancer with liver metastasis; 1 cholecystectomy for cholelithiasis (normal IOC), and 1 has lost follow up. Conclusions: 1) The success rate of a repeated ERCP for the same endoscopist was 87.5{\%}. 2) The clinical outcome of those with failed ERCP and a non-repeated attempt was dictated by the final diagnosis which was reached by other means.",
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N2 - Failure rates for cannulating the desired duct at ERCP vary from 5% to 15%. A first failed attempt may lead to a repeated study if clinically indicated, or otherwise to clinical follow up or an alternative diagnostic test. The success rate of a repeat ERCP in the hands of the same endoscopist is unknown. Objectives: To determine 1) the success rate of a repeat attempt at ERCP by the same operator and 2) the outcome of those patients with initially failed ERCP and non-repeated study. Material and Methods: Five-hundred consecutive ERCPs performed by or under the direct supervision of a single staff gastroenterologist at a VA Medical Center were reviewed. Results: A failed cannulation of the duct of interest at the initial ERCP occurred in 9.4% of cases (47 ERCPs). Eight (17%) of these, had BII anastomosis. The initially failed ducts were: CBD in 34 cases (72.3%). PD in 10 (21.2%), both ducts in 2 (4.2%) and the duct of Santorini in I (2.1%) Indications for patients in which the first attempt failed were: Jaundice (19.1%), Abnormal imaging study (US/CT) (23.4%). Pancreatitis (18%). Elevated alkaline phosphatase and stent placement (8%, each). Abdominal pain (6%), and Others (16%). ERCP was repeated by or under the same endoscopist's supervision in 24 cases (51%), in a median of 16 days later (Range:1 day to 2 years). The initially failed duct was successfully opacified/cannulated at the repeated attempt in 21 (87.5%) of these cases. A needle knife sphincterotomy was used in 5 cases (21%) and allowed the successful cannulation of the desired duct in 80% of them Of the 23 patients with initially failed cannulation and no repeated study, the final diagnosis were Cancer with/without liver metastasis in 8: cholecystectomy with normal intraoperative cholangiogram (IOC) in 2: AIDS in 2; no returned visits for symptoms or abnormal tests in 9; alcoholic pancreatitis in I and, death from sepsis in 1. Diagnosis of those with a failed repeated attempt. 1 cancer with liver metastasis; 1 cholecystectomy for cholelithiasis (normal IOC), and 1 has lost follow up. Conclusions: 1) The success rate of a repeated ERCP for the same endoscopist was 87.5%. 2) The clinical outcome of those with failed ERCP and a non-repeated attempt was dictated by the final diagnosis which was reached by other means.

AB - Failure rates for cannulating the desired duct at ERCP vary from 5% to 15%. A first failed attempt may lead to a repeated study if clinically indicated, or otherwise to clinical follow up or an alternative diagnostic test. The success rate of a repeat ERCP in the hands of the same endoscopist is unknown. Objectives: To determine 1) the success rate of a repeat attempt at ERCP by the same operator and 2) the outcome of those patients with initially failed ERCP and non-repeated study. Material and Methods: Five-hundred consecutive ERCPs performed by or under the direct supervision of a single staff gastroenterologist at a VA Medical Center were reviewed. Results: A failed cannulation of the duct of interest at the initial ERCP occurred in 9.4% of cases (47 ERCPs). Eight (17%) of these, had BII anastomosis. The initially failed ducts were: CBD in 34 cases (72.3%). PD in 10 (21.2%), both ducts in 2 (4.2%) and the duct of Santorini in I (2.1%) Indications for patients in which the first attempt failed were: Jaundice (19.1%), Abnormal imaging study (US/CT) (23.4%). Pancreatitis (18%). Elevated alkaline phosphatase and stent placement (8%, each). Abdominal pain (6%), and Others (16%). ERCP was repeated by or under the same endoscopist's supervision in 24 cases (51%), in a median of 16 days later (Range:1 day to 2 years). The initially failed duct was successfully opacified/cannulated at the repeated attempt in 21 (87.5%) of these cases. A needle knife sphincterotomy was used in 5 cases (21%) and allowed the successful cannulation of the desired duct in 80% of them Of the 23 patients with initially failed cannulation and no repeated study, the final diagnosis were Cancer with/without liver metastasis in 8: cholecystectomy with normal intraoperative cholangiogram (IOC) in 2: AIDS in 2; no returned visits for symptoms or abnormal tests in 9; alcoholic pancreatitis in I and, death from sepsis in 1. Diagnosis of those with a failed repeated attempt. 1 cancer with liver metastasis; 1 cholecystectomy for cholelithiasis (normal IOC), and 1 has lost follow up. Conclusions: 1) The success rate of a repeated ERCP for the same endoscopist was 87.5%. 2) The clinical outcome of those with failed ERCP and a non-repeated attempt was dictated by the final diagnosis which was reached by other means.

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