Mo1465 Is Double-Guidewire Technique Really Useful for Difficult Biliary Cannulation?

Abstract

Mo1465 Is Double-Guidewire Technique Really Useful for Difficult Biliary Cannulation? Su Jin Kim*, Dae Hwan Kang, Hyung Wook Kim, Cheol Woong Choi, Young MI Hong, Joung Boom Hong, Byoung Hoon Ji, MIN Dae Kim, Jae Hyung Lee Internal Medicine, Pusan National University Yangsan Hospital, YangSan -Si, Gyeongnam, Republic of Korea; Internal Medicine, Bongseng Memorial Hospital, Pusan, Republic of Korea Background and Aim: Double-guidewire technique (DGT) has been reported to be useful for difficult biliary cannulation. Needle-knife fistulotomy (NKF) is also used in failed standard biliary cannulation. The aim of this study was to compare the success rate and complications between the DGT and NKF in patients with difficult biliary cannulations. Methods: Patient who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2009 and September 2012 were eligible for this study. DGT or NKF were perfomed if deep biliary cannulation was not achieved despite of five mininutes of attempted cannulationthan or more than three attempted unintentional pancreatic cannulations. Patients with unsuccessful DGT underwent NKF as alternative procedure. The success rate of cannulation and the frequency of post-ERCP pancreatitis (PEP) were investigated. Result A total 1550 ERCP cases were analyzed, the total success rate of selective biliary cannulation was 94.2% (1460/1550). Of the 302 patients with unsuccessful standard cannulation technique, DGT was perfomed in 70 patients and NKF was perfomed in 199. The success rates in the DGT and NKF groups were 41.4% (29/70) versus 81.4% (162/ 199) (p 0.01). Thirty patients with unsuccessful DGT underwent NKF as alternative procedure, biliary cannulation was achieved in 70.0% (21/30). 3-step protocol (traditional cannula with guidewire, DGT, and NKF is performed sequentially) was no significant benefit in success rates compared with NKF only group (84.7% 50/59, p 0.453). The incidence rate of PEP was significantly higher in DGT group (20.0%, 14/70) than in NKF group (8.0%, 16/199) (p 0.01). There was no significant difference in bleeding incidence. Conclusion: DGT in patients with a difficult biliary cannulation resulted in a low success rate of biliary cannulation and a high incidence of PEP comparing with NKF. DGT before NKF had no statically additional benefit in cannulation success. We suggest that NKF should be considered as a first approach in difficult cannulation situations. Clinical Outcomes for cannulation