Guidewire cannulation increases the success rate of needle-knife fistulotomy for difficult bile duct access.
OBJECTIVE
Selective bile duct cannulation is a prerequisite for performing therapeutic endoscopic biliary intervention. This study aimed to evaluate if using a soft-tipped guidewire to cannulate the bile duct would increase the success rate of needle-knife fistulotomy for difficult bile duct access.


METHODS
We reviewed sixty 60 patients with difficult bile duct access who underwent conventional cannulation with radiocontrast dye (29) or guidewire cannulation (31) after needle-knife fistulotomy.


RESULTS
There were no significant differences in the demographic data between the two groups. The initial success rate of selective bile duct cannulation was significantly higher in the guidewire cannulation group compared with the conventional cannulation group: 100% versus 79.3%, P = 0.009. The success rate of selective biliary cannulation in the patients with non-dilated common bile duct (< 8 mm) was significantly higher in the guidewire cannulation group compared with the conventional cannulation group: 100% versus 68.4%, P = 0.003. The incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis was not significantly different between the two groups. No serious complications occurred in either group.


CONCLUSIONS
In this retrospective and small case series, guidewire cannulation after needle-knife fistulotomy increased the success rate of selective bile duct cannulation in patients with difficult bile duct access.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Kyoung W
KW
Yoon
Chang H
CH
Park
Seon Y
SY
Park
Sung B
SB
Cho
Wan S
WS
Lee
Young E
YE
Joo
Hyeun S
HS
Kim
Sung K
SK
Choi
Jong S
JS
Rew
D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation; D003287:Contrast Media; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology; D011677:Punctures; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome
D003287:Contrast Media