Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography.
OBJECTIVE
Although biliary cannulation with pancreatic guidewire placement (P-GW) is useful for difficult cases in endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of wire-guided cannulation with P-GW (double-guidewire technique: DGT) has not been clarified. The aim of the present study was to evaluate the usefulness of DGT for difficult biliary cannulation after unsuccessful biliary cannulation using a cannula/sphincterotome under guidance of injected contrast with P-GW (single-guidewire technique: SGT).


METHODS
One-hundred and forty-six patients with difficult biliary cannulation who underwent SGT were included in this retrospective study. DGT was carried out if SGT was unsuccessful. Pancreatic duct (PD) stenting was attempted to prevent post-ERCP pancreatitis (PEP) in all patients. The success rate of cannulation and the risk factors for PEP were investigated.


RESULTS
Biliary cannulation with SGT was achieved in 70%. DGT was carried out in 25 patients with unsuccessful SGT, biliary cannulation being successful in 72%. Of the 13 patients who underwent precut sphincterotomy, biliary cannulation was achieved in 46%. The incidence of PEP in patients who had undergone SGT, DGT, and precut sphincterotomy was 8% (12: mild, 8; moderate, 3; severe, 1), 4% (mild, 1), and 0%, respectively. PD stenting was successfully carried out in 86%. Multivariate analysis revealed unsuccessful PD stenting to be the only risk factor for PEP (OR 8.3, 95% CI 2.3-30).


CONCLUSIONS
DGT may replace SGT or become the salvage procedure in cases of unsuccessful SGT as a result of its high success rate with an acceptable incidence of PEP. Failed pancreatic duct stenting in these techniques was frequently associated with PEP.
Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
Kei
K
Ito
Jun
J
Horaguchi
Naotaka
N
Fujita
Yutaka
Y
Noda
Go
G
Kobayashi
Shinsuke
S
Koshita
Yoshihide
Y
Kanno
Takahisa
T
Ogawa
Kaori
K
Masu
Shinichi
S
Hashimoto
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000503:physiopathology / Q000601:surgery; D000704:Analysis of Variance; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002779:Cholestasis / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010183:Pancreatic Ducts / Q000503:physiopathology / Q000601:surgery*; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D016717:Sphincterotomy, Endoscopic / Q000009:adverse effects / Q000379:methods*; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome
biliary cannulation; endoscopic retrograde cholangiopancreatography (ERCP); pancreatic duct stenting; pancreatitis; wire-guided cannulation