title: Comparison between double-guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation.
abstract: OBJECTIVE
  The aim of the present study was to compare the effectiveness and complications of the double-guidewire technique (DWT) with the transpancreatic sphincterotomy (TPS) technique.
  
  
  METHODS
  From January 2013 to December 2014, 366 consecutive endoscopic retrograde cholangiopancreatography (ERCP) procedures were carried out. Of 366 procedures, 354 procedures were carried out in patients with native major papilla biliary cannulation. A total of 279 consecutive therapeutic ERCP were included in the study and data of included patients were collected retrospectively. One hundred and thirty-seven procedures (49.1%) were done with DWT and 142 procedures (50.9%) were done with TPS for patients with difficult cannulation. The results and complications of ERCP were compared.
  
  
  RESULTS
  Success rate of first-attempt cannulation was 62.0% in the DWT group and 81.0% in the TPS group (P = 0.00). Final rate of successful cannulation of the two biliary cannulation techniques was 86.9% and 90.8%, respectively (P = 0.09). Cannulation time in the DWT group was 7.8 ± 1.7 min compared with 3.7 ± 2.3 min in the TPS group (P = 0.00). Overall incidence of post-ERCP pancreatitis (PEP), hemorrhage, perforation and cholangitis was 1.8%, 1.1%, 0.4% and 1.1%, respectively. Adverse event rate was 2.19% in the DWT group and 7.04% in the TPS group (P = 0.04).
  
  
  CONCLUSIONS
  DWT and TPS procedures were safe and effective. Overall cannulation rate was similar between the groups. Although DWT had a longer cannulation time, it could be considered the preferred technique in patients with failed standard cannulation for lower adverse event rate.
authors.affiliation: Department of No. 1 Surgery, The First Hospital Affiliated to Anhui Chinese Medical University, Hefei, China.
authors.forename: Long
authors.initials: L
authors.lastname: Huang
authors.forename: Qing-sheng
authors.initials: QS
authors.lastname: Yu
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Ju-da
authors.initials: JD
authors.lastname: Liu
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000601:surgery*; D002404:Catheterization / Q000379:methods; D057785:Catheters; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: biliary cannulation; complication; double-guidewire technique; endoscopic retrograde cholangiopancreatography (ERCP); precut technique