title: Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP.
abstract: OBJECTIVE
  To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access.
  
  
  METHODS
  During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate.
  
  
  RESULTS
  SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients' gender.
  
  
  CONCLUSIONS
  Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.
authors.affiliation: Gastroenterology Unit, Hellenic Anticancer Institute Saint Savvas Hospital of Athens, 171 Alexandras Avenue, GR 11522, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Xinopoulos
authors.forename: Stefanos P
authors.initials: SP
authors.lastname: Bassioukas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kypreos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Korkolis
authors.forename: Andreas
authors.initials: A
authors.lastname: Scorilas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mavridis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Dimitroulopoulos
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Paraskevas
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000601:surgery*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic / Q000379:methods; D016896:Treatment Outcome