Is it worth to repeat endoscopic retrograde cholangiopancreaticography after failed precut? Short report from a tertiary care hospital in North India

Aim: The aim of this study is to determine the success rate of biliary cannulation in cases where endoscopic retrograde cholangiopancreatography (ERCP) is repeated after failed precut sphincterotomy. Materials and Methods: In this retrospective study, consecutive ERCPs performed between August 2013 and June 2017 were included. Data was analyzed for indication of ERCP, success rate at initial cannulation attempt, use of precut sphincterotomy, biliary access rate after precut, repeat ERCP rate, and associated complications. Results: A total of 1872 ERCPs were included in the study. Of these, 55% were done for common bile duct stones, 37% for malignant biliary obstruction, and 8% for biliary leak. During the initial ERCP, 84.9% cases had successful biliary cannulation. Nearly 86.8% cases undergoing precut sphincterotomy achieved biliary access. Repeat ERCP was done in 28 cases after a median interval of 3 days and biliary cannulation was achieved in 78.5% cases. Conclusion: Repeat ERCP after 3 days in cases of failed initial precut sphincterotomy should be practiced and recommended as this allows definitive biliary therapy in majority of such patients and prevents morbidity and mortality from other invasive alternative therapies.