الفهرس 
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Abstract
How to best achieve a safe and effective bile duct cannulation during ERCP has always been, and still is, a much-debated issue. Both technical- and patient-related aspects of cannulation and cannulation difficulties have previously been investigated. Frequency and predictors for papillary cannulation weren’t studied well in our locality.
So, the current study was conducted at Al-Rajhi University Hospital between January 2020 and January 2021. A total of 200 cases who underwent ERCP for different indications were eligible in the study. Out of those patients; successful papillary cannulation was achieved in 172 (86%) patients while in the other 28 (14%) patients, cannulation was failed.
Both groups of the studied patients based on the outcome of cannulation had insignificant differences as regard baseline, clinical and laboratory data with except of significantly higher mean body mass index among those patients with failed papillary cannulation (27.54 ± 4.01 vs. 25.17 ± 2.84 (kg/m2).
There was significant difference between both groups of patients based on different indications of ERCP where majority of patients with failed cannulation had malignant obstruction (89.3%). Meanwhile, majority of patients with successful cannulation had choledocholithiasis (61%).
Patients with failed cannulation had significantly higher frequency of complications. Thirteen (7.6%) patients and 3 (1.7%) patients with successful cannulation reported pancreatitis and bleeding while pancreatitis, bleeding and duodenal perforation reported in 10 (35.7%), 1 (3.6%) and 2 (7.1%) patients with failed cannulation, respectively.
In the current study, the most frequently reported causes of failure were abnormal variation in papilla (53.6%) and infiltrated papilla (28.6%) followed by altered anatomy with previous surgery in 4 (14.3%) patients and large juxa-papillary diverticulum in one patient.
Management of those patients was percutaneous transhepatic drainage (35.6%), second trail of ERCP (32.2%), surgical intervention (17.9%) and rendezvous technique (14.3%). Based on the current study, predictors of failed cannulation of major papilla were endoscopists experience < 5 years and malignant obstruction.