Pancreatic duct guidewire pre-occupying for difficult biliary cannulation in ERCP

Abstract

Objective To investigate the efficacy of pancreatic duct guidewire pre-occupying in ERCP with difficult biliary cannulation. Methods During a four-year study period from June 2008 to June 2012, a total of 3505 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique for up to 5 attempts, followed by double-guidewire technique when repeated unin- tentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when double-guidewire technique had failed or no pancreatic duct cannulation had been previously achieved. Biliary cannulation success and post- ERCP complication rate were compared. Results Single-guidewire technique was characterized by statistically significant higher success rate （93.4%）, compared with the double-guide- wire technique （54. 8%, P 〈 0. 001 ）, pre-cut failed double-guidewire technique （81.3%, P 〈 0. 001 ） or pre- cut as first step method （84. 6%, P =0. 011 ）. Pre-cut failed double-guidewire technique and pre-cut as first step method offered a statistically significantly more favorable outcome compared with the double-guidewire technique （both P 〈 0. 001 ）. The incidence of post-ERCP pancreatitis did not differ in a statistically signifi- cant manner among the four methods. Numbers of patients who got bleeding in pre-cut papillotomy technique and sphincterotomy after successful single-guidewire technique were 5 and 2 respectively. One case of perfora- tion was recorded using pre-cut papillotomy technique. There was no procedure-related mortality within 30 days. Conclusion Although double-guidewire technique success rate proved not to be superior to single- guidewire technique 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 difficuh-to-cannulate cases. Key words: Cholangiopancreatography, endoscopic retrograde; Sphincterotomy, endoscopic ; Postoperative complications