Wire-guided cannulation over a pancreatic stent versus double guidewire technique in patients with difficult biliary cannulation

BMC Gastroenterology

Min Kyeong Kim¹  Joon Koo Kang²  Soon Sun Kim²  Hyoung-Kyu Ryu²  Jin Hong Kim²  Byung Moo Yoo²  Jae Chul Hwang²  Min Jae Yang² 

[1] Medical Information and Media Center, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu 443-721, , Suwon, South Korea;Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu 443-721, , Suwon, South Korea

关键词: Pancreatic duct;    Bile duct;    Pancreatitis;    Cannulation;    Endoscopic retrograde cholangiopancreatography;   

Others  :  1234295
DOI  :  10.1186/s12876-015-0381-4

 received in 2015-07-02, accepted in 2015-10-21,  发布年份 2015

【 摘 要 】

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.

【 授权许可】

   
2015 Yang et al.

【 图 表 】

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