What to do when endoscopic retrograde cholangio-pancreatography fails? Personal experience.

Background: Endoscopic retrograde cholangio pancreatography failure is a rare and some dramatic reality too for the management of bilio-pancreatic tract disorders and in these cases it needs to utilize others operative technique.
Patients and Methods: Over a 6-year period, a total of 757 ERCPs were performed. In seventeen of these ERCPs the standard endoscopic technique failed and we employed alternative techniques such as interventional radiology or surgical management or double endoscopic approach.
Results: In all 17 failed ERCPs the alternative procedures allowed us to success in bilio-pancreatic disease.
Conclusion: ERCP is an operator-dependent procedure. Even in expert hands failure occurs in 3% to 10% of cases. ERCP failure doesn't be considerated a dramatic situation in the management of the bilio-pancreatic disease for a multidisciplinary team (endoscopist, surgeon and interventional radiologist) whose cooperation allows to success.