Difficult Common Bile Duct Cannulation Factors in Endoscopic Retrograde Cholangiopancreatography Procedure

Abstract

Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is the standard procedure for diagnosis and treatment of pancreatobiliary disease. Successful biliary cannulation will determine the next procedure. Selective biliary cannulation with a standard ERCP catheter or sphincterotome reportedly fails in 15-35 % cases. The factors associated with difficult biliary cannulation of ERCP procedure should be identified to prevent ERCP complications. The aim of this study was to determine the prevalence of difficult biliary cannulation and the factors associated to difficult biliary cannulation in ERCP procedure.

Methods: This research was conducted with cross sectional study in Gastrointestinal Endoscopy Center and Medical Record Unit Cipto Mangunkusumo Hospital, using medical records data of subjects who underwent ERCP from 2018-2020. Bivariate and multivariate analysis were performed for the factors that associated with difficult biliary cannulation.

Results: There were 194 subjects that enrolled in this study. The prevalence of difficult biliary canulation was 26,3% (51/194) cases. The prevalence of biliary obstructions were: non malignant (57.2%), non-CBD distal stricture (73.7%), no periampulary diverticle (91.8%).  The experiences ERCP operator was (53.1%). The prevalent of non-malignan CBD obstruction was multiple choledocholitiasis (16%). The prevalent of malignant biliary obstruction was cholangiocarsinoma (20,1%). Significant correlation of difficult CBD canulation to the age, direct bilirubin level and experience of ERCP operator. There was correlation although non-significant of difficult canulation to malignancy dan distal CBD stricture. No correlation of difficult canulation to comorbid and periampular diverticle.

Conclusions: The prevalence of difficult biliary cannulation in ERCP procedure was 26,3%. Age, direct bilirubin level, and operator experience were factors associated with difficult biliary cannulation in ERCP procedure. There was also related between difficult CBD canulation and malignancy dan distal CBD stricture although not significant.