ArticleDEN open2026
Stepwise Algorithm for Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography in the Era of Endoscopic Ultrasound-Guided Biliary Drainage: A Single-Center Retrospective Cohort Study.
Article in DEN open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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8 authors.
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Abstract
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential procedure for the management of biliary diseases. Successful biliary cannulation is the first step. Advanced cannulation techniques, such as the double-guidewire technique (DGW), precut techniques, and endoscopic ultrasound (EUS)-guided rendezvous (RV), have been developed to improve cannulation success. However, comprehensive evaluations of a structured cannulation algorithm remain limited. Aims: To evaluate the status of biliary cannulation and associated adverse events (AEs) using a stepwise cannulation algorithm. Methods: A retrospective evaluation of 1,000 consecutive patients with a naïve papilla who underwent ERCP for biliary disease was performed between 2012 and 2022. Biliary cannulation was attempted using a stepwise algorithm, beginning with wire-loaded cannulation (WLC), followed by DGW, precut techniques, and EUS-RV. The primary endpoint was overall technical success; secondary endpoints included AEs, incidence of post-ERCP pancreatitis (PEP), and risk factor analysis. Results: Initial WLC achieved selective biliary cannulation in 69.2% of cases. Salvage techniques achieved high success rates: DGW (74.9%), precut techniques (77.6%), and EUS-RV (97.0%). Overall, the final cannulation success rate was 97.8%. The overall AE rate was 7.5%, with PEP being the most common (6.1%). AEs were significantly more frequent in advanced cannulation techniques than WLC (13.3% vs. 5.2%, Conclusion: A structured stepwise approach achieves very high biliary cannulation success in patients with a naïve papilla, though advanced cannulation techniques increase AE risk. Appropriate timing and positioning of EUS-RV may further optimize safety and efficacy in biliary cannulation.
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