{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T01:46:54Z","timestamp":1766627214507,"version":"3.40.3"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Prolonged cannulation during endoscopic retrograde cholangiopancreatography (ERCP) increases risk of complications, particularly post-ERCP pancreatitis (PEP). This study aimed to determine optimal timing to discontinue ERCP when selective biliary cannulation (SBC) cannot be easily achieved.<\/jats:p><jats:p>Patients with na\u00efve papilla who underwent ERCP between January 2021 and December 2021 were analyzed. The primary outcome was to determine optimal timing for discontinuing ERCP based on cannulation success rate and complication rate.<\/jats:p><jats:p>A total of 272 patients with na\u00efve papilla underwent ERCP. Trainees did not participate in any of the procedures. Median age was 71 years, and 152 patients (55.9%) were male. The most common indication for ERCP was choledocholithiasis (60.7%), followed by malignant obstruction (24.3%) and benign stricture (4.8%). SBC was achieved in 249 patients (91.5%). After excluding patients with pre-procedure amylase elevation or preexisting pancreatitis, 232 patients were analyzed for complications. Eighteen patients (6.7%) experienced complications, with PEP occurring in 15 patients (5.5%). SBC success was achieved in 50% of cases at 3.3 minutes and in 90% at 12.1 minutes. In contrast, the PEP rate reached 10% after 7.9 minutes and 14.5% after 12.1 minutes. Multivariate analysis identified distal biliary stricture and age over 70 as significant predictors of difficult SBC.<\/jats:p><jats:p>In cases of difficult SBC, discontinuing attempts at around 8 minutes may minimize risk of PEP. However, extending attempts up to 12 minutes can be justified to achieve higher success rates. Beyond 12 minutes, likelihood of successful SBC diminishes significantly.<\/jats:p>","DOI":"10.1055\/a-2536-8241","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:06:49Z","timestamp":1739232409000},"source":"Crossref","is-referenced-by-count":1,"special_numbering":"S","title":["Optimal timing for discontinuation of ERCP in cases of difficult selective biliary cannulation"],"prefix":"10.1055","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9246-3819","authenticated-orcid":false,"given":"Han Taek","family":"Jeong","sequence":"additional","affiliation":[{"name":"Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea (the Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jimin","family":"Han","sequence":"additional","affiliation":[{"name":"Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea (the Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,4,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","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":"PA Testoni","year":"2016","journal-title":"Endoscopy"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1186\/s12876-020-01455-0","article-title":"Duodenal major papilla morphology can affect biliary cannulation and complications during ERCP, an observational study","volume":"20","author":"PH Chen","year":"2020","journal-title":"BMC Gastroenterol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.dld.2021.07.010","article-title":"Difficult biliary cannulation in patients with distal malignant biliary obstruction: An underestimated problem?","volume":"54","author":"A Fugazza","year":"2022","journal-title":"Dig Liver Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"5953","DOI":"10.1007\/s00464-020-08080-8","article-title":"Impact of periampullary diverticulum on biliary cannulation and ERCP outcomes: a single-center experience","volume":"35","author":"F Tabak","year":"2021","journal-title":"Surg Endosc"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"188","DOI":"10.21037\/atm-22-4697","article-title":"Prolonged cannulation time is an independent risk factor for moderate-to-severe post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis: a large cohort study","volume":"11","author":"L Lou","year":"2023","journal-title":"Ann Transl Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1515260","DOI":"10.1155\/2017\/1515260","article-title":"Number of endoscopic retrograde cholangiopancreatography procedures required for short biliary cannulation time","volume":"2017","author":"K Mandai","year":"2017","journal-title":"Gastroenterol Res Pract"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0016-5107(91)70740-2","article-title":"Endoscopic sphincterotomy complications and their management: an attempt at consensus","volume":"37","author":"PB Cotton","year":"1991","journal-title":"Gastrointest Endosc"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/jhbp.512","article-title":"Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos)","volume":"25","author":"S Kiriyama","year":"2018","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.gii.2012.08.006","article-title":"Endoscopic management of procedure-related bleeding","volume":"1","author":"LM Wong Kee Song","year":"2012","journal-title":"Gastrointest Intervention"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1177\/2050640616674837","article-title":"Endoscopic classification of the papilla of Vater. 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