Wire-guided cannulation over a pancreatic stent versus double guidewire technique in patients with difficult biliary cannulation.
BACKGROUND
In cases of difficult bile duct cannulation, the use of wire-guided cannulation over a pancreatic stent (WGC-PS) or the double guidewire technique (DGT) may facilitate biliary cannulation. The aim of this study was to compare the outcomes of WGC-PS and DGT in patients with difficult biliary cannulation.


METHODS
We conducted a retrospective cohort study of all endoscopic retrograde cholangiopancreatographies (ERCPs) performed between July 2009 and November 2014 at a single tertiary referral center. WGC-PS or DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. In those cases, we used the WGC-PS technique from July 2009 to January 2012 (WGC-PS group), and the DGT technique from February 2012 to November 2014 (DGT group). In the DGT group, WGC-PS was sequentially performed if successful biliary cannulation was not achieved during the DGT attempt. Consecutive patients who underwent DGT and/or WGC-PS with the aim of selective biliary cannulation were enrolled. The primary outcome parameter was the rate of initial successful biliary cannulation.


RESULTS
During the study period 3270 ERCPs were performed and a total of 177 patients were enrolled. The rate of initial successful cannulation was 66.7 % (60/90) in the WGC-PS group and 70.1 % (61/87) in the DGT group (P = 0.632). In 26 cases of failed DGT, WGC-PS was sequentially performed in the DGT group, and cannulation was successful in 14 of these patients. The rate of successful cannulation without the needle-knife precut technique was significantly higher in the DGT group compared with the WGC-PS group (75/87, 86.2 % vs. 60/90, 66.7 %, P = 0.003). The incidence of post-ERCP pancreatitis was 3.3 % (3/90) in the WGC-PS group and 10.3 % (9/87) in the DGT group (P = 0.077).


CONCLUSIONS
In patients for whom biliary cannulation was difficult and PD access was inadvertently achieved while attempting the standard WGC technique, both WGC-PS and DGT were equally effective. Furthermore, the stepwise approach using DGT followed by WGC-PS as needed facilitated successful biliary cannulation and reduced the need for the needle-knife precut technique.
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. creator1999@hanmail.net.
Min Jae
MJ
Yang
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. cath07@naver.com.
Jae Chul
JC
Hwang
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. ybm6403@gmail.com.
Byung Moo
BM
Yoo
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. jinhkim@ajou.ac.kr.
Jin Hong
JH
Kim
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. calryuis@daum.net.
Hyoung-Kyu
HK
Ryu
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. cocorico99@gmail.com.
Soon Sun
SS
Kim
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. pellucida@hotmail.com.
Joon Koo
JK
Kang
Medical Information and Media Center, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. min3942@hanmail.net.
Min Kyeong
MK
Kim
D000328:Adult; D001652:Bile Ducts; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010183:Pancreatic Ducts; D010195:Pancreatitis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome