Effect of Indirect Biliary Cannulation on Endoscopic Retrograde Cholangiopancreatography Outcome

Background and aim: - Variable techniques could be used to raise the success rate and reduce complications of endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods: - From 73 patients subjected to ERCP in our endoscopy unit, during the period between January 2016 to December 2017, 47 patients were managed with standard free direct cannulation maneuver (group- I), 21 patients managed with indirect maneuvers (DGT andor TPS as group-II) and ERCP was failed in 5 cases; in 3 of them temporary pancreatic stent was placed but with no value. Results: - From 73 patients, standard free direct cannulation was done in 47 patients with success rate 64.4%, the remaining 26 patients managed with indirect maneuvers with successful cannulation of CBD in 21 cases with success rate 80.7% and total success rate of 94.4%. Procedure duration was longer in patients of indirect maneuvers than patients of standard free direct cannulation maneuver, with high significant difference (P value of 0.0036). The post-ERCP complications were noticed in 21 patients with complications rate of 28.8 %. Complications were significantly higher in patients of indirect maneuvers than patients of standard direct maneuver (47.6% vs. 23.4%). Post-ERCP pancreatitis recorded in 7 patients (9.6%) with significant higher rate in patients of indirect maneuvers than patients of direct maneuver (23.8% vs. 4.3%). Conclusion: - Indirect biliary cannulation (DGT and/or TPS) solved the problem of failed cannulation but had a higher rate of complications and took longer time.