title: Dye-free wire-guided cannulation of the biliary tree during ERCP is associated with high success and low complication rates: outcomes in a single operator experience of 822 cases.
abstract: BACKGROUND
  Deep biliary cannulation (DBC) is a prerequisite to most endoscopic retrograde cholangiopancreatographies (ERCPs). Numerous techniques have been described to maximize success and minimize ERCP-related complications, most notably post-ERCP pancreatitis. Dye-free cannulation by using guidewires with hydrophilic tips has been proposed as a technique with a high rate of success and a low rate of complications. We report the outcomes 822 consecutive ERCP procedures by using dye-free guidewire cannulation techniques.
  
  
  OBJECTIVE
  To evaluate the success rate for DBC and rates of complications by using dye-free guidewire cannulation techniques.
  
  
  METHODS
  Retrospective. Consecutive ERCP procedures with intent to achieve DBC exclusively by using dye-free guidewire technique were included. Complication data on post-ERCP pancreatitis, bleeding, perforation, and cholangitis were extracted.
  
  
  METHODS
  University.
  
  
  METHODS
  Patients undergoing biliary ERCP.
  
  
  METHODS
  ERCP.
  
  
  METHODS
  Success, complication rates.
  
  
  RESULTS
  Eight hundred and twenty-two ERCPs were performed on 744 patients. Five hundred and fifty-nine (68%) procedures were performed on inpatients, 263 (32%) on outpatients. DBC was successful in 801 of 822 (97%) ERCPs. In 795 of 801 (99%) ERCPs with successful DBC procedures, DBC was achieved in a dye-free fashion. Eleven patients (1.3%) developed post-ERCP pancreatitis-all cases were mild. Guidewire perforations occurred 11 times (1.3%), none required surgery. Ten of 11 patients with known or suspected (91%) guidewire perforation achieved successful DBC on repeat ERCP by the same endoscopist by using dye-free techniques.
  
  
  CONCLUSIONS
  Retrospective.
  
  
  CONCLUSIONS
  In this large retrospective case series, a high success rate of DBC was achieved by using dye-free guidewire techniques. This technique has associated lower rates of complications in comparison to those reported earlier.
authors.affiliation: Therapeutic Endoscopy, Gastroenterology and Hepatology, Huntsman Cancer Center, University of Utah, Salt Lake City, Utah, USA. douglas.adler@hsc.utah.edu
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Adler
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Verma
authors.forename: Kristen
authors.initials: K
authors.lastname: Hilden
authors.forename: Romil
authors.initials: R
authors.lastname: Chadha
authors.forename: Kristen
authors.initials: K
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract; D001660:Biliary Tract Diseases / Q000175:diagnosis; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult