Use of the mini-forceps traction-assisted cannulation technique when standard ERCP methods fail: Single-center retrospective study.

BACKGROUND AND STUDY AIMS

There are few salvage techniques for achieving biliary cannulation when no duct can be accessed.

PATIENTS AND METHODS

We retrospectively reviewed 10 consecutive cases in which the mini-forceps traction-assisted cannulation technique (MFTAC) was used after failure of any duct access during endoscopic retrograde cholangiopancreatography (ERCP). Outcomes included technical success, use of adjunct techniques; time to biliary access; and adverse events (AEs).

RESULTS

Most patients had a native papilla (n = 9) of peri-diverticular location (n = 5) and a benign indication (n = 6). Standard cannulation was unsuccessful over 8:23 mm:ss (interquartile range [IQR] 6:04-19:43). MFTAC had 100% technical success, achieved biliary access after 17:38 mm:ss (IQR 8:52-20:31), and had a 10% incidence of AEs (post-ERCP pancreatitis). MFTAC was sufficient to allow biliary cannulation in three cases and allowed pancreatic duct access in seven cases, which then allowed biliary cannulation with double-wire technique (5/10) and transpancreatic septotomy (2/10).

CONCLUSIONS

MFTAC is a feasible salvage approach for biliary access when standard cannulation methods fail.