Reducing Risk During Biliary Cannulation in ERCP


Endoscopic Retrograde Cholangiopancreatography (ERCP) has grown tremendously over the last few decades. Some of the most common indications for ERCP include choledocholithiasis, acute biliary pancreatitis, ascending cholangitis, unspecified choledochal obstruction, and pancreatic head mass.

Extensive training and experience are required to achieve high success rates when it comes to biliary cannulation. Surgeons who’ve completed high ERCP case volumes (350+ procedures) or perform the procedure frequently, typically have failure rates less than 20% during cannulation.1

But successful cannulation is also susceptible to many factors outside physician proficiency. This includes anatomy (surgically altered, tortuous, tumor infiltration, papillary stenosis), patient positioning, and level of sedation. An increased number of cannulation attempts (>5) or increased time to complete cannulation (>5-10 minutes) could increase risk of complications.2,3

Advanced Therapeutic Endoscopists are keenly aware of these risks and the fact that trauma to the papilla from a failed cannulation greatly increases the risk of post-ERCP pancreatitis (PEP).4 Studies show that using guidewire-assisted cannulation can significantly reduce this risk.4 Using a sphincterotome that enables precision and control may also contribute to reduced risk.

ERCP-induced complications can increase length of hospital stays and healthcare costs, which are heavily examined in today’s environment due to an uptick in value-based initiatives. Physicians are seeking tools to help them advance their therapeutic endoscopic techniques and outcomes. Could innovation in sphincterotomy devices contribute to this mission?

Dr. Sammy Ho, Gastroenterologist specializing Pancreatic /Biliary Endoscopy (ERCP), Endoscopic Ultrasound, and Endoscopy, commented on his experience with a novel steerable sphincterotome. “The orientation feature is really unique, and the maneuverability of the tip helped with cannulation,” said Dr. Ho. 

Dr. Kamran Ayub, an Advanced Endoscopist who specializes in all areas of interventional endoscopy, also had the chance to evaluate the new CompleteControl™ Sphinctertome during a procedure. A patient presented to Dr. Ayub with pain in their upper right quadrant. A CT revealed a dilated common bile duct. During the procedure it was identified that the patient has Sphincter of Oddi Dysfunction. CompleteControl™’s ability to orient in Dr. Ayub’s desired direction supported cannulation during his case. “It has the wow factor on tip orientation, nearly 1:1,” he recalled. “And the insulated wire is great. It will help fellows know how much wire should be in the patient.”

To learn more about how CompleteControl™ can impact your ERCP procedures, click here

1 Kröner, Paul T et al. “Use of ERCP in the United States over the past decade.” Endoscopy international open vol. 8,6 (2020): E761-E769. doi:10.1055/a-1134-4873
2 European Society of Gastrointestinal Endoscopy. (2016). Guidelines for the management of patients with acute overt lower gastrointestinal bleeding [PDF file]. Retrieved from
3 Liao, W.-C., Angsuwatcharakon, P., Isayama, H., Dhir, V., Devereaux, B., Khor, C. J. L., Ponnudurai, R., Lakhtakia, S., Lee, D.-K., Ratanachu-ek, T., Yasuda, I., Dy, F. T., Ho, S.-H., Makmun, D., Liang, H.-L., Draganov, P. V., Rerknimitr, R., & Wang, H.-P. (2017). International consensus recommendations for difficult biliary access. In Gastrointestinal Endoscopy (Vol. 85, Issue 2, pp. 295–304). Elsevier BV.
4 Baillie, John. “Difficult endoscopic retrograde cholangiopancreatography.” Gastroenterology & hepatology vol. 10,1 (2014): 49-51.