World Endoscopy Organization guidelines on endoscopic retrograde cholangiopancreatography biliary cannulation and sphincterotomy techniques

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Crinò S.F.; Aabakken L.; Bapaye A.; Chan S.; Kida M.; Law R.; Maluf-Filho F.; Mekaroonkamol P.; de Moura E.G.H.; Bestetti A.; Mostafa I.; Park D.H.; Rajaram R.B.; Reddy N.D.; Seo D.W.; Pittayanon R.; Teoh A.Y.B.

Journal: Digestive Endoscopy

Publisher: John Wiley and Sons Inc

Publication Date: 16 June 2025

Volume / Issue: Volume 37 / Issue 10

Pages: 1029–1053

ISSN: 9155635

DOI: 10.1111/den.15060

Scopus: View on Scopus

PubMed: 40518920

Document Type: Article

Authors and Affiliations

Crinò S.F., Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy; Aabakken L., Department of Transplantation Medicine, Section of Gastroenterology, Oslo University Hospital, Oslo, Norway, Faculty of Clinical Medicine, University of Oslo, Oslo, Norway; Bapaye A., Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Maharashtra, Pune, India; Chan S., Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong; Kida M., Department of Gastroenterology, Kitasato University Hospital, Sagamihara, Japan; Law R., Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States; Maluf-Filho F., Instituto do Cancer do Estado de São Paulo (ICESP), São Paulo, Brazil, Department of Gastroenterology, University of São Paulo, São Paulo, Brazil; Mekaroonkamol P., Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand; de Moura E.G.H., Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Bestetti A., Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Mostafa I., Department of Gastroenterology and Hepatology, Theodor Bilharz Research Institute Cairo, Cairo, Egypt; Park D.H., Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea; Rajaram R.B., Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; Reddy N.D., Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; Seo D.W., Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, South Korea; Pittayanon R., Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand; Teoh A.Y.B., Surgery Centre, Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong

Abstract

Recent guidelines on biliary cannulation are lacking. This guideline is an initiative of the World Endoscopy Organization (WEO) with the involvement of a panel of experts from Asia, Europe, and America. Relevant clinical questions on four areas (post-endoscopic retrograde cholangiopancreatography [ERCP] pancreatitis [PEP] prophylaxis, biliary cannulation techniques, sphincterotomy/papillary balloon dilation, and biliary cannulation in special circumstances) were developed and answered after systematic reviews of the literature and using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Successful biliary cannulation and sphincterotomy are cornerstones of ERCP and are indispensable for almost all therapeutic and advanced diagnostic procedures. However, adverse events, particularly PEP, may commonly occur and impair patients' outcomes. A high cannulation rate and a low rate of PEP are quality indicators for ERCP and should be the goal of all endoscopists. With this guideline we aimed to provide clinical practice advice applicable worldwide, regardless of resources and expertise availability. The main recommendations focus on specific aspects of ERCP, including pre-, intra-, and postprocedural measures to reduce the risk of PEP, the technique for an initial biliary cannulation attempt, options for cannulation in cases of difficult biliary access, alternatives to ERCP in case of failure (percutaneous- and endoscopic ultrasound-guided), and biliary access in altered anatomy (periampullary diverticulum and postsurgical anatomy) and in the presence of duodenal stenosis. © 2025 Japan Gastroenterological Endoscopy Society.

Keywords

biliary stricture; difficult biliary cannulation; endoscopic retrograde cholangiopancreatography; papillary dilation; post-ERCP pancreatitis; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreatitis; Sphincterotomy, Endoscopic; diclofenac; sodium chloride; Article; balloon dilatation; biliary cannulation; bleeding; cholangitis; cholestasis; clinical practice; clinical practice guideline; common bile duct; duodenum; duodenum stenosis; endoscopic ultrasonography; endoscopist; gastrectomy Billroth II; human; practice guideline; prophylaxis; sphincterotomy; adverse event; endoscopic sphincterotomy; etiology; prevention and control; procedures

Citation Information

Scopus Citations: 22

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