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Comparison between double‐guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation
Author(s) -
Huang Long,
Yu Qingsheng,
Zhang Qi,
Liu Juda,
Wang Zhen
Publication year - 2015
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/den.12387
Subject(s) - medicine , endoscopic retrograde cholangiopancreatography , perforation , surgery , pancreatitis , major duodenal papilla , adverse effect , bile duct , ampulla of vater , punching , materials science , metallurgy , carcinoma
Background and Aim 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 J anuary 2013 to D ecember 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.