Endoscopic Retrograde Cholangiopancreatography Results 3 Days After a Failed Pre-cut.

INTRODUCTION Deep cannulation of the common bile duct is essential in endoscopic retrograde cholangiopancreatography (ERCP). However, with the use of the usual techniques, it is not possible to cannulate in approximately 20% of the cases. Pre-cutting is an alternative that allows cannulation in difficult cases although its success is not guaranteed. Repeating the ERCP within three days of a failed pre-cut is an acceptable option. OBJECTIVE To determine if an ERCP done three days after a failed pre-cut papillotomy allows the bile duct to be cannulated without increasing complication rates. PATIENTS AND METHODS Patients with ERCP plus pre-cut were included for whom the common bile duct could not be cannulated and who underwent a new ERCP three days after the initial pre-cut. The primary objective was a successful biliary cannulation in the second ERCP, and the secondary objective were the complications of the initial pre-cutting. RESULTS Forty patients with an average age of 65 were identified and 57% were men. The indications for ERCP were: choledocholithiasis 95%, biliary fistula 2.5%, and pancreatic neoplasia 2.5%. The ERCP was repeated 3 days later in 92.5% of the cases and the biliary cannulation was successful in 78.3%. CONCLUSIONS A new ERCP done within three days of a failed pre-cut is justifiable since it has a significant success rate. In 3 out of 4 patients, bile duct cannulation is achieved with an acceptable percentage of complications.