{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:32:01Z","timestamp":1785324721704,"version":"3.55.0"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81970557"],"award-info":[{"award-number":["81970557"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2002The 5\u20135\u20131 criteria (&gt;\u200a5 minutes \u2013 5 cannulation attempts \u2013 1 unintended pancreas duct cannulation) were proposed by the European Society of Gastrointestinal Endoscopy to define difficult biliary cannulation. However, the criteria may be inappropriate for trainee-involved procedures. We developed criteria for difficult cannulation in trainee-involved procedures.<\/jats:p><jats:p>\n          Methods\u2002Patients undergoing biliary cannulation with or without trainee involvement were eligible. Procedures that might be too easy (e.\u200ag. fistula) or too difficult (e.\u200ag. altered anatomy) were excluded. The primary outcome was difficult cannulation, defined as cannulation time, attempts, or inadvertent pancreatic duct (PD) cannulation exceeding the 75\u200a% percentile of each variable. Propensity score matching (PSM) analysis was used.<\/jats:p><jats:p>\n          Results\u2002After PSM, there were 1596 patients in each group.\u200aTrainee-involved procedures had longer median (interquartile range [IQR]) cannulation time (7.5 [2.2\u201315.3] vs. 2.0 [0.6\u20135.2] minutes), and more attempts (5 [2\u201310] vs. 2 [1\u20134]) and inadvertent PD cannulation (0 [0\u20132] vs. 0 [0\u20131]) vs. procedures without trainee involvement (all P\u200a&lt;\u200a0.001). The 15\u201310\u20132 criteria for difficult cannulation were proposed for trainee-involved cannulation and the 5\u20135-1 criteria were nearly confirmed for cannulation without trainee involvement. The proportions of difficult cannulation using these respective criteria were 35.5\u200a% (95\u200a% confidence interval [CI] 33.2\u200a%\u201337.9\u200a%) and 31.8\u200a% (95\u200a%CI 29.5\u200a%\u201334.2\u200a%), respectively (odds ratio 1.18 [95\u200a%CI 1.02\u20131.37]). Incidences of post-ERCP pancreatitis following difficult cannulation were comparable (7.8\u200a% [95\u200a%CI 5.7\u200a%\u201310.3\u200a%] vs. 9.8\u200a% [95\u200a%CI 7.4\u200a%\u201312.8\u200a%], respectively).<\/jats:p><jats:p>\n          Conclusion\u2002By using the 75\u200a% percentiles as cutoffs, the proposed 15\u201310\u20132 criteria for difficult cannulation could be appropriate in trainee-involved procedures. <\/jats:p>","DOI":"10.1055\/a-1523-0780","type":"journal-article","created":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T22:38:47Z","timestamp":1622846327000},"page":"447-454","source":"Crossref","is-referenced-by-count":24,"title":["Difficult biliary cannulation in ERCP procedures with or without trainee involvement: a comparative study"],"prefix":"10.1055","volume":"54","author":[{"given":"Xu","family":"Wang","sequence":"first","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Luo","sequence":"first","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Tao","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui","family":"Ren","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangping","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhui","family":"Liang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linhui","family":"Zhang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Shi","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuegang","family":"Guo","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanglin","family":"Pan","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.gie.2016.09.037","article-title":"International consensus recommendations for difficult biliary access","volume":"85","author":"W C Liao","year":"2016","journal-title":"Gastrointest 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as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs","volume":"49","author":"J Halttunen","year":"2014","journal-title":"Scand J Gastroenterol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.clinre.2018.09.004","article-title":"Management of difficult or failed biliary access in initial ERCP: a review of current literature","volume":"43","author":"Q Chen","year":"2019","journal-title":"Clin Res Hepatol Gastroenterol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1055\/s-0042-108641","article-title":"Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline","volume":"48","author":"P A Testoni","year":"2016","journal-title":"Endoscopy"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1016\/j.cgh.2015.06.035","article-title":"Early precut sphincterotomy does not increase 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cholangiopancreatography pancreatitis in patients undergoing double-guidewire assisted biliary cannulation: A case-control study with propensity score matching","author":"X Wang","year":"2021","journal-title":"J Gastroenterol Hepatol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.gie.2015.10.022","article-title":"Variation in learning curves and competence for ERCP among advanced endoscopy trainees by using cumulative sum analysis","volume":"83","author":"S Wani","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1111\/den.13377","article-title":"Patient-related factors associated with successful cannulation by trainees during hands-on endoscopic retrograde cholangiopancreatography training","volume":"31","author":"L Zheng","year":"2019","journal-title":"Dig 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Rep"}],"container-title":["Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1523-0780.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T09:54:43Z","timestamp":1660125283000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1523-0780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,4]]},"references-count":19,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2022,4,21]]},"published-print":{"date-parts":[[2022,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1523-0780","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0013-726X","1438-8812"],"issn-type":[{"value":"0013-726X","type":"print"},{"value":"1438-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,6,4]]},"published":{"date-parts":[[2021,6,4]]}}}