Predictors of Difficult or Failed Endoscopic Retrograde Cholangiopancreatography Cannulation in Clinical Practice

Abstract

Purpose: Difficult/failed endoscopic retrograde cholangiopancreatography (ERCP) cannulation rates range from 5%-20% and is an independent risk factor for post ERCP complications. The aim of our study was to determine clinical, biochemical and patient demographic factors that predict difficult or failed ERCP cannulation. Methods: Retrospective chart review of all patients who underwent ERCP procedure between January 2006 and October 2008 at two community medical centers was performed and appropriate demographic, clinical and biochemical factors were extracted for analysis. All patients who underwent ERCP for the first time were included in the study and all patients with a previous history of ERCP procedure were excluded. Difficult ERCP cannulation was defined when there was difficulty/failure to cannulate the ampulla or if the total duration of the procedure exceeded 45 minutes. Univariate and multivariate logistic regression analysis was performed to identify the predictors of difficult/failed cannulation. Results: 220 patients underwent ERCP of which 146 patients (Table 1) who met the inclusion criteria were included in the study. 25% (n=36) of patients had difficult/failed ERCP cannulation. Multivariate analysis revealed previous gastrointestinal (GI) surgery (OR 2.59; 95% CI 1.21-5.57; p=0.01), age (OR 1.03 95% CI 1.01-1.06 P value 0.0017) and history of smoking (OR 3.16; 95% CI 1.43 - 6.97; p=0.004) to be significantly associated with difficult or unsuccessful cannulation.Table 1: Baseline characteristics of the patientsConclusion: Elderly patients, smokers and patients with prior GI surgery are at a higher risk for difficult or failed ERCP cannulation. These factors needed to be considered when individualizing the choice of technique prior to ERCP.