Improvement of successfulness of endoscopic retrograde cholangiopancreatography

Background and aim: Imaging of aimed duct and performing of planned endoscopic therapy are unsuccessful in 10–20% of endoscopic retrograde cholangiopancreatographies (ERCPs). The aim was to evaluate the possibilities for improvement of successfulness in a prospective study.

Method: 84.0% out of 1012 ERCPs (including 41 cases of previous unsuccessful attempts of other examiners) were performed successfully in last 3-yr-period. The causes of failure were pyloric or duodenal stenosis in 26 patients (2.6%), duodenal diverticulum (DD) in 25 patients (2.5%), Billroth II. partial gastrectomy (B II) in 19 patients (1.9%) and others in 92 patients. Precut in 71 patients and pancreatic sphincterotomy (PEST) in 10 patients were executed to improve the success rate.

Results: Precut and PEST enlarged the success rate of ERCPs with 6.8% to 90.8% (in DD from 72.8% to 80.4%, in B II from 48.8 to 59.5%). Complications occurred after precut in 2/72 cases were exsudative pancreatitis (EP) and in 6/71 cases hyperamylasemia (HA), after PEST in 1/10 case EP and in 1/10 case HA.

Conclusion: Precut and PEST proved to be safe and effective to increase the success rate of ERCP.