To analyze the causes of endoscopic retrograde cholangiopancreatography(ERCP)failure in Beijing Friendship Hospital with a specific focus on the effectiveness of different salvage treatments to provide evidence for the treatment strategy selection after ERCP failure.

The patients who underwent ERCP at Beijing Friendship Hospital from June 1, 2020 to September 1, 2022 were enrolled, and the reasons and salvage treatment of the failure cases were analyzed.

A total of 2534 ERCP cases were included, of which 57 cases failed.The failure rate of emergency ERCP was significantly higher than that of inpatients(6.19% vs.1.26%, P<0.01).Noticeably, papilla abnormality-resulted ERCP failure was much more common in beginners(52.6%)and proficient doctors(31.3%), as compared to skilled doctors(P<0.05).In salvage treatment, the success rate of second-ERCP(65%)and medication-based treatment(60%)was significantly lower than that of percutaneous transhepatic cholangial drainage(PTCD)(93.8%)(P<0.05).The re-treatment rate of PTCD(56.3%)and medication-based treatment(60%)was significantly higher than that of surgery(0%)and endoscopic ultrasonography(0%)(P<0.05).The clinical remission rate of medication-based treatment(60%)was significantly lower than that of second-ERCP(95%)(P<0.05).

Emergency ERCP is not recommended for beginners.For the treatment of ERCP failure, more active salvage treatment are recommended, and endoscopic ultrasonography or surgical treatment should be given priority if applicable.