Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques

Figure 1 Annual endoscopic retrograde cholangiopancreatography volume progressively increased from 2008 to 2018. ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 2 Mean age of patients progressively increased significantly from 2008 to 2018.

Figure 3 Proportion of endoscopic retrograde cholangiopancreatography performed for management of malignant biliary strictures increased from 2008 to 2018, but this did not reach statistical significance.

Figure 4 Proportion of endoscopic retrograde cholangiopancreatography performed with the duodenoscope in a non-standard position increased significantly from 2008 to 2018.

Figure 5 Progressive increase in the frequency of ampullary distortion/tumor infiltration, duodenal distortion/stenosis and peri-ampullary diverticula was noted in over the study period. ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 6 Utilization of more than one advanced cannulation technique for a given endoscopic retrograde cholangiopancreatography increased significantly over the study period.

Figure 7 Over the study period, there was an increasing proportion of procedures with oropharyngeal, esophageal, gastric and duodenal barriers to duodenoscope advancement and cannulation. A: Qropharyngeal barriers to duodenoscope advancement and cannulation; B: Esophageal barriers to duodenoscope advancement and cannulation; C: Gastric barriers to duodenoscope advancement and cannulation; D: Duodenal barriers to duodenoscope advancement and cannulation.