Is the double‐guidewire technique superior to the pancreatic duct guidewire technique in cases of pancreatic duct opacification?

Background and Aims Pancreatic duct guidewire placement ( P ‐ GW ) techniques include both the injection cannulation technique with a contrast medium and wire‐guided cannulation without contrast injection for selective biliary cannulation; the latter is the so‐called “double‐guidewire technique” ( D ‐ GW ). The aim of this study was to compare the outcomes between P ‐ GW and D ‐ GW for biliary cannulation. Methods The procedures for biliary cannulation with a naïve papilla were performed in a total of 363 cases. We divided the patients chronologically, according to the time period during which the procedures were performed, into two groups: group A , P ‐ GW performed from M arch 2008 to J une 2009; and group B , D ‐ GW performed from J uly 2009 to D ecember 2010. The success rates and complication rates were evaluated in each group. Results Biliary cannulation was successful in 31 (81.6%) patients in the P ‐ GW group and 34 patients (82.9%) in the D ‐ GW group. The onsets of postendoscopic retrograde cholangiopancreatography pancreatitis ( PEP ) occurred in the P ‐ GW and D ‐ GW groups were four (10.5%) and three (7.3%) patients, respectively, and all were mild cases ( P  = 0.616). The frequency of hyperamylasemia and the serum amylase level tended to be lower in the D ‐ GW group than in the P ‐ GW group ( P  = 0.213). There was a statistically significant difference on the onsets of PEP in the GW and non‐ GW groups ( P  = 0.04, 8.9% and 1.1%, respectively). Conclusions Both the D ‐ GW and P ‐ GW techniques were equally effective for difficult biliary cannulation. Furthermore, the complication rates, including PEP , were similar in both techniques. A prospective randomized trial is warranted.