Predictive Factors of Biliary Cannulation Failure

Abstract

Introduction: Endoscopic biliary drainage continues to evolve and now plays a central role in the management of biliary tract strictures of lithiasic, tumoral, or other origins. The aim of our study is to report our outcomes with endoscopic biliary drainage via endoscopic retrograde cholangiopancreatography (ERCP) and to identify factors associated with cannulation failure. Materials and Methods: This is a retrospective, descriptive, and analytical study conducted. It covers an eight-year period, from January 2017 to January 2024, and includes all patients who underwent therapeutic ERCP. During the endoscopic procedure, all patients received general anesthesia with orotracheal intubation to ensure airway protection and optimal sedation. Subsequently, patients were positioned in the left lateral decubitus position to facilitate endoscopic access. Prior to the intervention, a non-steroidal anti-inflammatory drug (NSAID) was administered rectally as a prophylactic measure to reduce the risk of post-procedural inflammation and pancreatitis. Results: During the study period, 407 therapeutic ERCP procedures were performed. Cannulation failure occurred in 7% of cases, representing 30 patients. The predictive factors of biliary cannulation failure identified in our study were: an impacted stone in the distal common bile duct, the appearance of the duodenal papilla, and an intradiverticular location of the papilla. Conclusion: Our study demonstrated that the location and appearance of the duodenal papilla, as well as the presence of an impacted stone in the distal common bile duct, are significant factors influencing the risk of biliary cannulation failure.