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Abstract

We thank Hakuta et al1Hakuta R. Hamada T. Nakai Y. et al.Pancreatic stent during biliary cannulation: How can we catch 2 hares?.Gastrointest Endosc. 2019; 89: 648-649Scopus (1) Google Scholar for their interest in and comments on our study.2Eminler A.T. Parlak E. Koksal A.S. et al.Wire-guided cannulation over a pancreatic stent method increases the need for needle-knife precutting in patients with difficult biliary cannulation.Gastrointest Endosc. 2019; 89: 301-308Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar We agree that repeated guidewire cannulation of the pancreatic duct may increase the risk of post-ERCP pancreatitis. Although there is some debate on this isssue, we think that successful insertion of a prophylactic pancreatic stent, inadvertent cannulation of the side branches of the pancreatic duct, and injection of contrast material are among the determining factors. Additionally, there is some controversy about the timing of pancreatic stent insertion, which usually depends on the preference of the endoscopists. We prefer to insert a pancreatic stent immediately after biliary sphincterotomy, not at the end of the procedure. Finally, the authors emphasized the usefulness of a nontouch technique during wire-guided cannulation over a pancreatic stent, especially in a patient with a small ampulla. The success of this technique depends on the patient’s anatomy, the position of the duodenoscope, and other factors such as a papilla with a small orifice. We also prefer this technique in some cases; however, only 1 randomized trial has compared the touch and nontouch techniques with naïve papillae, and it revealed a significantly higher primary cannulation rate in favor of the touch technique, with similar adverse event rates.3Bassi M. Luigiano C. Ghersi S. et al.A multicenter randomized trial comparing the use of touch versus no-touch guidewire technique for deep biliary cannulation: the TNT study.Gastrointest Endosc. 2018; 87: 196-201Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar Pancreatic stent during biliary cannulation: How can we catch 2 hares?Gastrointestinal EndoscopyVol. 89Issue 3PreviewUnintentional guidewire insertion to the pancreatic duct commonly occurs during biliary cannulation and provokes post-ERCP pancreatitis (PEP).1 Several cannulation approaches have been reported in this setting.2,3 In a recent issue of Gastrointestinal Endoscopy, Eminler et al4 reported that the double-guidewire (DGW) method was superior to wire-guided cannulation after pancreatic stent placement (WGC-PS) in terms of the successful cannulation rate: 90% versus 54%. Notably, they proceeded to precut sphincterotomy over a pancreatic stent after 5 minutes of cannulation attempts. Full-Text PDF