Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

Abstract

Aim: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access.

Methods: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate.

Results: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients' gender.

Conclusion: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Keywords: Endoscopic retrograde cholangiopancreatography; Pancreatic duct; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Pre-cut papillotomy.

Figure 1

Endoscopic view of the papilla with a hydrophilic wire advanced into the pancreatic duct. A sphincterotome is advanced alongside the pancreatic wire with its tip oriented in the anticipated bile duct position.

Figure 2

Biliary cannulation with the use of double-guidewire technique. One guidewire has been inserted into the distal part of the pancreatic duct and another is being moved in the direction of common bile duct through the sphincterotome inserted into the ampulla.