Deep common bile duct cannulation time at endoscopic retrograde cholangiopancreatography: a forgotten parameter for assessment of endoscopic competence?

The rate of successful deep common bile duct cannulation (DCBD) at endoscopic retrograde cholangiopancreatography (ERCP) is usually used as a surrogate marker of competence at ERCP. There are few data regarding the time spent on cannulation at ERCP. This prospective study aimed to evaluate the time spent on DCBD cannulation at ERCP and to provide a rationale for establishing the DCBD cannulation time as another parameter in assessment of ERCP competence. This is a prospective study performed in a single tertiary university-based referral center. DCBD cannulation time as well as the fluorescence time and the cost of cannulation tools during DCBD cannulation were measured. The mean DCBD cannulation was 12.5±13.6 minutes. Eighty-percent of the cannulation was achieved within 10 min, 10% achieved in 10-30 min, and the remaining in longer than 30 min. The longer cannulation time was associated with increased the cost of cannulation ($79/cannulation versus $387/ cannulation, P<0.001), as well as increasing the radiation exposure times (3.1 min/cannulation vs. 25 min/cannulation, P<0.001). In addition to the success rate of DCBD cannulation, the DCBD cannulation time should be considered as another parameter in the assessment of endoscopic competence in ERCP.