title: Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation.
abstract: OBJECTIVE
  To compare the outcomes between double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) in patients with difficult biliary cannulation.
  
  
  METHODS
  This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34) and TPS (n = 37) groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications.
  
  
  RESULTS
  The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001). Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0.
  
  
  CONCLUSIONS
  When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group.
authors: Department of Internal Medicine, Gastroenterology and Hepatobiliary Center, Cheongju St. Mary's Hospital, Cheongju 360-568, South Korea.
authors: Young Wook
authors: YW
authors: Yoo
authors: Sang-Woo
authors: SW
authors: Cha
authors: Woong Cheul
authors: WC
authors: Lee
authors: Sae Hee
authors: SH
authors: Kim
authors: Anna
authors: A
authors: Kim
authors: Young Deok
authors: YD
authors: Cho
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000601:surgery; D001660:Biliary Tract Diseases / Q000601:surgery*; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods*; D019723:Endoscopes; D005260:Female; D006470:Hemorrhage / Q000150:complications / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D016896:Treatment Outcome
keywords: Duoble guidewire technique; Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Transpancrestic precut sphincterotomy