Deep Common Bile Duct Cannulation Time at Endoscopic Retrograde Cholangiopancreatography: A Forgotten Parameter for Assessment of Endoscopic Competence?

Abstract

Purpose: The rate of successful deep common bile duct (DCBD) cannulation at endoscopic retrograde cholangiopancreatography (ERCP) is often used as a surrogate marker of competence at ERCP. An 80% cannulation rate is often used to define competence, and this is usually achieved after performing about 200 ERCPs. Limited data exist in the current literature regarding the use of time spent on cannulation during ERCP as a standard to assess competence. The objective of this study is to evaluate the time spent on DCBD at ERCP and to provide a rationale for establishing the DCBD time as another parameter in assessment of ERCP competence. Methods: This prospective study was performed at a single tertiary university-based referral center on consecutive patients who presented for ERCP, between September 2003 and June 2004. The DCBD cannulation times, fluoroscopy times, and the cost for cannulation tools during DCBD cannulation were assessed. Patients who had a history of sphincterotomy, biliary stenting, or a recent ERCP within 7 days prior to the study were excluded. Results: A total of 102 patients were enrolled in the study. Of these, successful cannulations were achieved in 94 patients (92%). The procedure was aborted in four patients secondary to sedation problems or presence of unstable vitals. The remaining ninety patients completed the procedure. Of these, 38 were females and 52 were males with a mean age of 58 years. The mean DCBD cannulation time was 12.5±13.6 minutes. Eighty-percent of the cannulations were achieved within 10 minutes, 10% were achieved in 10 to 30 minutes, and the remaining 10% took longer than 30 minutes. The longer cannulations were associated with an increased cost of cannulation and increased radiation exposure (Table 1).Table: Table. Comparison of cost and radiation exposure during cannulationConclusion: Our study suggests that shorter cannulation times could reduce the expense of ERCP and decrease the radiation exposure during the procedure. Therefore, in addition to the success rate of DCBD cannulation, the DCBD cannulation time should be considered as another parameter in assessment of endoscopic competence in ERCP.