Bile duct cannulation for ERCP therapy : success rates for techniques and devices at a single institution

Background and study aims : Deep bile duct cannulation is the first step in carrying out ERCP biliary interventions. Although many special techniques have been described, there is a lack of reports that describe all methods employed to cannulate in a sin- gle series. This is a prospective study about the way in which can- nulation was achieved in an ordinary ERCP workload. Patients and methods : From January 2002 to June 2004, all patients who underwent ERCP with accessible and intact papilla and no gastroduodenal surgical alterations were included. Cannulation either with a 5.5 french tapered, triple lumen sphinc- terotome (5.5 Fr-S), loaded with a 0.035 inch hydrophilic tip guidewire, or with a 3 french tapered, double lumen sphinctero- tome (3 Fr-S), plus a 0.025 inch guidewire, was considered stan- dard cannulation (SC). Other methods and devices were consid- ered to be alternative methods. Results : Of the 199 patients, SC succeeded in 150 (75.4%). Initial cannulation was achieved in 78/100 with the 3 Fr-S, and in 59/96 (61.4%) with the 5.5 Fr-S, (p = 0.01). Alternative methods used to reach a final 98% success rate were any type of precut (23 patients, 11.5%), cannulation above a pancreatic placed guidewire (11, 5.5%), above a pancreatic stent (7, 3.5%), utiliza- tion of two devices at the same time (3, 1.5%), and papillectomy (1, 0.5%). In 4 (2%) patients, cannulation failed. Conclusions : In almost a quarter of the patients (45, 22.6%) in this series, cannulation had to be performed by alternative meth- ods. A 3 Fr-S is a very useful tool for gaining access to the bile duct. (Acta gastroenterol. belg., 2006, 69, 261-267).