A retrospective analysis to assess the importance of doing a biliary sphincterotomy as a method to increase and simplify cannulation success rate of the main pancreatic duct

Aims A retrospective analysis to assess the importance of doing a biliary sphincterotomy as a method to increase and simplify cannulation success rate of the main pancreatic duct.

Methods Retrospective analysis of pancreatic ERCP from October 2008 to May 2023 (n=1206) in our tertiary care center.

All cases were done by a single operator.

All cases where MPD could not be cannulated in three attempts, or MPD not cannulated directly in 10 minutes or CBD cannulated first were studied.

When direct MPD cannulation failed we attempted to cannulate the CBD first or when CBD was first cannulated during an MPD cannulation, we did a biliary sphincterotomy wide enough to separate the biliary and pancreatic orifices and then cannulated the MPD with a cannula and a glide wire.

Results N=1206 Successful direct MPD cannulation: 982 ( 81.4%) Difficult Cannulation: 224 (18.6%) CBD cannulated first: 199 out of 224 ( 88.9%) Biliary Sphincterotomy done: 199 (100%) Successful MPD Cannulation after biliary sphincterotomy: 185 (92.9%) Failed MPD cannulation after biliary sphincterotomy: 14 (7.03%) Pancreas Divisum found: 10/14- failed cannulations (71.4%) Failed MPD cannulation overall: 25 out of 1206 (2.07%)

Conclusions If direct MPD cannulation is difficult, cannulating the CBD first and doing a biliary sphincterotomy improves the MPD cannulation success rate significantly- from 81.4% to 92.9%. Out of failed MPD cannulation after biliary sphincterotomy, 71.4% cases had pancreas Divisum which was not detected on prior imaging. Those who could not be cannulated at all were subjected to EUS guided drainage/surgery.

Publication History

Article published online:
15 April 2024