Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial.
BACKGROUND
ERCP can be associated with serious complications. Difficulty in common bile duct (CBD) cannulation is one of the main risk factors for post-ERCP pancreatitis. The double-guidewire technique (DGT) has been considered a promising alternative approach in difficult cannulation situations.


OBJECTIVE
To compare the performance of DGT with the standard cannulation technique (SCT) in patients in whom CBD cannulation is difficult to perform.


METHODS
Multicenter randomized, controlled trial.


METHODS
Six tertiary referral centers.


METHODS
A total of 188 patients with difficult CBD cannulation defined by completion of 5 unsuccessful cannulation attempts were enrolled.


METHODS
Ninety-seven patients were assigned to the DGT group and 91 to the SCT group. Both techniques were compared for an extra 10 cannulation attempts.


METHODS
CBD cannulation rate, number of attempts required to cannulate, and ERCP-related complications.


RESULTS
Successful CBD cannulation was achieved in 46 of 97 (47%) patients in the DGT group compared with 51 of 91 (56%) in the SCT group (OR 0.85; 95% CI, 0.64-1.12). The median number of attempts required for each group was 9 and 7, respectively (P = .128). The incidence of post-ERCP pancreatitis was 17% in the DGT group and 8% in the SCT group (OR 2.13; 95% CI, 0.89-5.05).


CONCLUSIONS
Reduced number of enrolled subjects and a lack of detailed information regarding the number and extent of pancreatic duct contrast injections.


CONCLUSIONS
In patients with difficult CBD cannulation, DGT was not superior to SCT in achieving CBD cannulation. DGT might be associated with a higher risk of post-ERCP pancreatitis.
Herreros de Tejada
Alberto
A
Department of Gastroenterology, Puerta de Hierro Hospital, Autónoma University, Joaquín Rodrigo 2, 28222 Majadahonda Madrid, Spain. albertoherreros@yahoo.com
Calleja
Jose Luis
JL
Díaz
Gonzalo
G
Pertejo
Virginia
V
Espinel
Jesús
J
Cacho
Guillermo
G
Jiménez
Javier
J
Millán
Isabel
I
García
Fernando
F
Abreu
Luis
L
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D003135:Common Bile Duct; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged