title: Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: Results of a retrospective study with historical controls comparing two therapeutic sequential strategies.
abstract: OBJECTIVE
  Endoscopic access to the common bile duct (CBD) remains difficult in 10% of cases, requiring alternative techniques .CBD access was difficult after either five unsuccessful attempts, five unintentional insertions into the pancreatic duct or >10-min-long unsuccessful attempts. This retrospective study with historical controls aimed to evaluate the benefit of the double guidewire (DGW) technique after failure of standard CBD cannulation.
  
  
  METHODS
  From January 2012 to December 2014, all patients requiring therapeutic endoscopic retrograde cholangiopancreatography (ERCP) with difficult access to CBD were included in a Studied group. This group was compared to a historical ERCP control group from January 2009 to December 2011. In the Studied group, a sequential strategy including DGW technique was done when the guidewire was unintentionally passed into the pancreatic duct. In the control group, only pre-cut technique was used.
  
  
  RESULTS
  Among the 538 patients with naive papilla eligible for ERCP, 73 had difficult CBD access. Successful CBD access rate was higher in the Studied group: 91% (50/55) versus 67% (12/18) P = 0.0215. Complication rates were similar in both groups: 28% versus 20%, P = 0.5207. LOS was shorter in the Studied group (9.2 ± 8.5 vs 14.4 ± 7.4 days, P = 0.0028). Post-ERCP cholangitis were lower in the Studied group: 2% (1/55) versus 22% (4/18), P = 0.0118.
  
  
  CONCLUSIONS
  After standard cannulation failure, DGW technique increased successful CBD access rate and decreased LOS without increasing complications.
authors.affiliation: Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France.
authors.forename: Arthur
authors.initials: A
authors.lastname: Laquiere
authors.affiliation: Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Desilets
authors.affiliation: Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France.
authors.forename: Arthur
authors.initials: A
authors.lastname: Belle
authors.affiliation: Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Castellani
authors.affiliation: Gastroenterology Department, La Timone Hospital, Marseille, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Grandval
authors.affiliation: Gastroenterology Department, La Timone Hospital, Marseille, France.
authors.forename: René
authors.initials: R
authors.lastname: Laugier
authors.affiliation: Alphabio Laboratory , European Hospital, Marseille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Penaranda
authors.affiliation: Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lecomte
authors.affiliation: Hepato-Gastroenterology Department, Saint Joseph Hospital, Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Boustiere
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects* / Q000379:methods*; D003137:Common Bile Duct Diseases / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic
keywords: catheterization; common bile duct; double guidewire technique; endoscopic retrograde cholangiopancreatography; pancreatic duct