Colan-Hernandez J, et al. - In this work, researchers assessed the efficacy, safety, and factors related to a second ERCP after failed cannulation using a precut sphincterotomy. A second ERCP after failure of initial biliary cannulation following precut seemed safe and effective. They recommended delaying the second ERCP at least 4 days if feasible.

Methods

• All patients that underwent an ERCP with native papilla were reviewed from 2006 to 2014 at two tertiary institutions.
• Based on the cannulation rate of the second ERCP, efficacy was determined, and safety was assessed in terms of adverse events.

Results

• 112 patients were identified with failed cannulation after precut; a second ERCP was performed in 72 (64.3%).
• The procedures were performed at median interval of 7 days (IQR 5–11).
• Researchers noticed achievement of deep cannulation in 54 cases (75%).
• Cannulation failure seemed only associated with an ERCP within 4 days after the initial precut (cannulation success 44.4 vs. 79.4% after 4 days, p = 0.026).
• After the first ERCP, adverse events were recorded in 13 of 112 patients (11.8%): delayed bleeding in four, pancreatitis in five, and perforation in four.
• After the second ERCP, adverse events were identified in three of 72 patients (4.2%): two delayed bleeding and one pancreatitis.