Frequency and Causes of Failed Endoscopic Retrograde Cholangiopancreatography in AL-Rajhi Endoscopy Unit

Abstract

Background and study aim: Endoscopic retrograde cholangiopancreatography (ERCP) is a well-known procedure with both diagnostic and therapeutic utilities in managing pancreaticobiliary conditions. Both technical- and patient-related aspects of cannulation and cannulation difficulties have previously been investigated. The current study aimed to assess the frequency and predictors for papillary cannulation. Patients and Methods: The current study was conducted at Al-Rajhi University Hospital between January 2020 and January 2021. 200 cases who underwent ERCP for different indications were eligible for the study. Reviewing the medical records of those patients with data collection related to the procedure of ERCP. Results: Out of those patients, successful papillary cannulation was achieved in 172 (86%) patients, while in the other 28 (14%) patients, cannulation failed. Both groups of the studied patients based on the outcome of cannulation had insignificant differences as regards baseline, clinical, and laboratory data. The most frequently reported causes of failure were abnormal variation in papilla (53.6%) and infiltrated papilla (28.6%) followed by altered anatomy with previous surgery in 4 (14.3%) patients and large juxa-papillary diverticulum in one patient. Based on the current study, predictors of failed cannulation of major papilla were endoscopists experience < 5 years and malignant obstruction. Conclusion: ERCP still has some sort of difficulty during canulation.Earlyprediction of those patients who are vulnerable to failure of cannulation would have a great effect on their outcome with a reduction in the frequency of expected complications. Frequent multicenter studies are warranted to confirm such results.