Initial experience in visualized biliary cannulation during ERCP.

Background Selective biliary cannulation is the most challenging step in endoscopic retrograde cholangiopancreatography (ERCP) because only indirect X-ray images can be obtained. Therefore, we developed a novel endoscopic retrograde direct cholangioscopy (ERDC) technology to facilitate visible biliary cannulation. Methods We used ERDC to treat 21 patients with common bile duct stones who were enrolled consecutively between July 2022 and December 2022. The procedure details and complications were recorded, and all patients were followed up for 3 months after the procedure. The learning curve effect was analyzed by comparing the early and later cases. Results Biliary cannulation was successful in all patients, and the stones were removed completely. The median time of cholangioscopy-guided biliary cannulation was 240.0 (10.0, 430.0) seconds, and the median number of cannulation procedures was 2.0 (1.0, 5.0). Despite one case of post-ERCP pancreatitis, one case of cholangitis, and three cases of asymptomatic hyperamylasemia, all patients recovered after symptomatic treatment, being discharged without serious adverse events at 3 months follow-up. Compared with the early cases, the number of intubations and use of guidewire guidance decreased in later cases. Conclusion Our research confirms that ERDC is a feasible technology for biliary cannulation under direct vision.