title: Pancreatic duct guidewire-indwelling method for patients resistant to selective biliary cannulation and usefulness of pre-cut papillotomy following unsuccessful biliary cannulation with pancreatic duct guidewire-indwelling method.
abstract: OBJECTIVE
  Pancreatic duct guidewire-indwelling method (P-GW) is effective when selective biliary cannulation (SBC) has failed, but neither its true success rate nor a salvage technique have been established. In this study, we examined the usefulness of pre-cut papillotomy employing a pancreatic duct guidewire as the salvage treatment after unsuccessful SBC under P-GW.
  
  
  METHODS
  P-GW was conducted in 55 patients. When cannulation under P-GW was unsuccessful, pre-cut papillotomy was performed. Then, if SBC after trial was still unsuccessful, ERCP was tried again at a later date. The incidence of pancreatitis following ERCP in patients with difficult SBC, with and without pancreatic duct stenting was determined.
  
  
  RESULTS
  P-GW resulted in successful SBC in 63.6% of patients. For the 20 patients in which SBC failed pre-cut papillotomy using the pancreatic duct guidewire was performed. Transpancreatic pre-cut papillotomy was performed in 17 patients; 3 patients underwent needle-knife pre-cut papillotomy. SBC was successful at first attempt in 89.1% and eventually in 96.4% of patients. Post-ERCP pancreatitis occurred in 7.3%, broken down into 0% for those with pancreatic duct stenting (p=0.03) and 16.7% for those without.
  
  
  CONCLUSIONS
  Pre-cut papillotomy using a pancreatic duct guidewire was useful for patients with unsuccessful SBC with P-GW alone, and the risk for pancreatitis was reduced by pancreatic stenting.
authors.affiliation: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan. sakai4754@yahoo.co.jp
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sakai
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Rintaro
authors.initials: R
authors.lastname: Mikata
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Shin
authors.initials: S
authors.lastname: Yasui
authors.forename: Reiko
authors.initials: R
authors.lastname: Eto
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Ryo
authors.initials: R
authors.lastname: Tamura
authors.forename: Seiko
authors.initials: S
authors.lastname: Togo
authors.forename: Motohisa
authors.initials: M
authors.lastname: Tada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishihara
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D000681:Amylases / Q000097:blood; D002404:Catheterization / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000453:epidemiology / Q000517:prevention & control; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D015607:Stents
chemical_list: D000681:Amylases