DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.029

Pages: 2240-2243

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is an essential technique for biliary drainage in obstructive jaundice caused by pancreatic head cancer. However, failure of biliary cannulation remains a major limitation of the procedure. Objective: To determine the rate of ERCP failure and identify clinical, radiological, and endoscopic factors associated with failure in patients with pancreatic head cancer. Patients and Methods: Single-center observational study including 43 patients who underwent ERCP for pancreatic head cancer between January 2023 and January 2026 at the Mohammed V Military Instruction Hospital in Rabat. ERCP failure was defined as the inability to achieve effective endoscopic biliary drainage. Categorical variables were compared between successful and failed ERCP groups using Fisher's exact test or the Chi-square test. Results: The mean age was 67.4 ± 11.5 years; 35 patients were male (81.4%). ERCP failure occurred in 13 patients (30.2%), primarily due to failed papillary cannulation (10 cases). Failure was significantly associated with the absence of sphincterotomy (p < 0.001), absence of common bile duct (CBD) dilatation (p < 0.001), absence of distal CBD stricture on cholangiography (p < 0.001), and non-placement of a biliary stent (p < 0.001). No significant differences were observed regarding age, sex, smoking history, diabetes, tumor stage, or presence of hepatic metastases. Conclusion: In this series, ERCP failure occurred in approximately one in three patients and was mainly driven by failed papillary cannulation. These findings highlight the importance of early recognition of difficult ERCP procedures and prompt referral to rescue techniques, particularly interventional endoscopic ultrasound (EUS).