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

作者：Stefano Francesco Crinò, Lars Aabakken, Amol Bapaye, Shannon Melissa Chan, Mitsuhiro Kida, Ryan J. Law, Fauze Maluf‐Filho, Parit Mekaroonkamol, Eduardo Guimarães Hourneaux de Moura, Alexandre Moraes Bestetti, Mostafa Ibrahim, Do Hyun Park, Ruveena Bhavani Rajaram, D. Nageshwar Reddy, Dong Wan Seo, Rapat Pittayanon, Anthony Yuen Bun Teoh · 发表于：Digestive Endoscopy · 年份：2025 · DOI：10.1111/den.15060 · 被引用次数：25 · 研究领域：Gallbladder and Bile Duct Disorders、Pancreatic and Hepatic Oncology Research、Esophageal and GI Pathology

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 biliar...