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.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging