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

Yang MJ, Hwang JC, Yoo BM, Kim JH, Ryu HK, Kim SS, Kang JK, Kim MK - BMC Gastroenterol (2015)

Bottom Line: 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).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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. creator1999@hanmail.net.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Double guidewire technique for biliary cannulation. a Bile duct cannulation was aimed upward to the 10–11 o’clock position in relation to the pancreatic wire. b, c Successful biliary cannulation with a second guidewire was achieved after the previous insertion of the first guidewire into the pancreatic duct
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Fig2: Double guidewire technique for biliary cannulation. a Bile duct cannulation was aimed upward to the 10–11 o’clock position in relation to the pancreatic wire. b, c Successful biliary cannulation with a second guidewire was achieved after the previous insertion of the first guidewire into the pancreatic duct

Mentions: DGT was performed as follows. A guidewire was inserted into the PD to at least half of the presumed total length of the PD (guided by fluoroscopy). A sphincterotome was reinserted along the first guidewire after being reloaded with the second guidewire. The tip of the device was positioned in the ampulla, bending over the pancreatic wire and targeting the 10–11 o’clock position on the ampullary orifice, to attempt cannulation of the bile duct. WGC of the bile duct was attempted alongside the pancreatic wire (Fig. 2). After successful biliary cannulation, the pancreatic wire was removed from the PD with or without pancreatic stenting at the discretion of the endoscopist.Fig. 2


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

Yang MJ, Hwang JC, Yoo BM, Kim JH, Ryu HK, Kim SS, Kang JK, Kim MK - BMC Gastroenterol (2015)

Double guidewire technique for biliary cannulation. a Bile duct cannulation was aimed upward to the 10–11 o’clock position in relation to the pancreatic wire. b, c Successful biliary cannulation with a second guidewire was achieved after the previous insertion of the first guidewire into the pancreatic duct
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4625430&req=5

Fig2: Double guidewire technique for biliary cannulation. a Bile duct cannulation was aimed upward to the 10–11 o’clock position in relation to the pancreatic wire. b, c Successful biliary cannulation with a second guidewire was achieved after the previous insertion of the first guidewire into the pancreatic duct
Mentions: DGT was performed as follows. A guidewire was inserted into the PD to at least half of the presumed total length of the PD (guided by fluoroscopy). A sphincterotome was reinserted along the first guidewire after being reloaded with the second guidewire. The tip of the device was positioned in the ampulla, bending over the pancreatic wire and targeting the 10–11 o’clock position on the ampullary orifice, to attempt cannulation of the bile duct. WGC of the bile duct was attempted alongside the pancreatic wire (Fig. 2). After successful biliary cannulation, the pancreatic wire was removed from the PD with or without pancreatic stenting at the discretion of the endoscopist.Fig. 2

Bottom Line: 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).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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, 443-721, , Suwon, South Korea. creator1999@hanmail.net.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus