Open Access Research article

Predicting native papilla biliary cannulation success using a multinational Endoscopic Retrograde Cholangiopancreatography (ERCP) Quality Network

Chunyan Peng12, Paul J Nietert3, Peter B Cotton1, Daniel T Lackland4 and Joseph Romagnuolo13*

Author Affiliations

1 Division of Gastroenterology and Hepatology, Medical University of South Carolina, 25 Courtenay Drive, ART 7100A, Charleston, SC 29425, USA

2 Division of Gastroenterology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, P R. China

3 Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC USA

4 Department of Neurosciences, Medical University of South Carolina, Charleston, SC USA

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BMC Gastroenterology 2013, 13:147  doi:10.1186/1471-230X-13-147

Published: 10 October 2013



Success in deep biliary cannulation via native ampullae of Vater is an accepted measure of competence in ERCP training and practice, yet prior studies focused on predicting adverse events alone, rather than success. Our aim is to determine factors associated with deep biliary cannulation success, with/ without precut sphincterotomy.


The ERCP Quality Network is a unique prospective database of over 10,000 procedures by over 80 endoscopists over several countries. After data cleaning, and eliminating previously stented or cut papillae, two multilevel fixed effect multivariate models were used to control for clustering within physicians, to predict biliary cannulation success, with and without allowing “precut” to assist an initially failed cannulation.


13018 ERCPs were performed by 85 endoscopists (March 2007 - May 2011). Conventional (without precut) and overall cannulation rates were 89.8% and 95.6%, respectively. Precut was performed in 876 (6.7%). Conventional success was more likely in outpatients (OR 1.21), but less likely in complex contexts (OR 0.59), sicker patients (ASA grade (II, III/V: OR 0.81, 0.77)), teaching cases (OR 0.53), and certain indications (strictures, active pancreatitis). Overall cannulation success (some precut-assisted) was more likely with higher volume endoscopists (> 239/year: OR 2.79), more efficient fluoroscopy practices (OR 1.72), and lower with moderate (versus deeper) sedation (OR 0.67).


Biliary cannulation success appears influenced by both patient and practitioner factors. Patient- and case-specific factors have greater impact on conventional (precut-free) cannulation success, but volume influences ultimate success; both may be used to select appropriate cases and can help guide credentialing policies.