Difficult Biliary Cannulation

International consensus group guidelines for endoscopists encountering difficult biliary access

Target Audience: Gastroenterologists, endoscopists

Background and Objective

Endoscopic retrograde cholangiopancreatography (ERCP) is the standard therapeutic intervention for biliary tract disease. However, this procedure is not always possible due to difficult biliary access (defined as failure to access the major papilla or unsuccessful biliary cannulation using standard ERCP within 10 minutes or after five attempts). An international consensus group has now conducted a comprehensive literature search and developed consensus recommendations to guide endoscopists encountering difficult biliary access.

Key Recommendations

When faced with difficult biliary access, avoid persisting with ERCP. Consider repeating attempts after 24 to 48 hours or us…

Reviewing Author

David A. Johnson, MD

Disclosures

Consultant/Advisory boardMedscape/WebMD; Pfizer; CRH Medical Corporation; Aries

EquityCRH Medical Corporation

Editorial boardsMedscape Gastroenterology

Leadership positions in professional societiesAmerican College of Gastroenterology Research Institute Board of Directors