# Difficult biliary cannulation among patients with compensated liver cirrhosis: predictors and impact on complications

## TL;DR

This study found that difficult biliary cannulation is common in patients with liver cirrhosis and increases the risk of ERCP complications.

## Contribution

The study identifies specific predictors of difficult biliary cannulation in cirrhotic patients undergoing first-time ERCP.

## Key findings

- Difficult biliary cannulation occurred in 45.5% of patients with compensated liver cirrhosis.
- DBC was associated with a 12.6% complication rate, including pancreatitis and minor bleeding.
- Predictors of DBC included older age, type 2 and 3 papillae, duodenal diverticulum, and precut sphincterotomy.

## Abstract

This study investigated prospectively how frequent is difficult biliary cannulation (DBC) among patients with compensated liver cirrhosis and how it will impact the ERCP related complications. Over a period of 2-years, patients with compensated liver cirrhosis undergoing their first time ERCP with naive papilla were evaluated by history, clinical examination, investigations, imaging and ERCP and followed up for any adverse events. Out of 131 compensated cirrhotic patients; 127 were successfully cannulated and included in the final analysis and divided into easy (n = 72) and difficult (n = 55) cannulation groups. The mean age of the studied cases was 51.86 ± 11.98 years (19–78) with male predominance (51.2% versus 48.8%). The most frequent indication for ERCP was calcular obstructive jaundice. DBC was reported among 45.5% of cases. DBC was associated with 12.6% complication rate of them 8.7% had pancreatitis and 3.9% had intraoperative minor bleeding. Older age, type 2 and 3 papillae, duodenal diverticulum and precut sphincterotomy were predictors of DBC. DBC is not uncommon among compensated cirrhotic patients experiencing their first time ERCP. Because DBC is associated with ERCP complications, its predictors should be considered especially the type of papilla, the presence of duodenal diverticulum and assisted cannulation techniques.

The online version contains supplementary material available at 10.1038/s41598-026-41040-1.