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Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography.
Dig Endosc 2014; 26(3):442-9DE

Abstract

BACKGROUND AND AIM

Although biliary cannulation with pancreatic guidewire placement (P-GW) is useful for difficult cases in endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of wire-guided cannulation with P-GW (double-guidewire technique: DGT) has not been clarified. The aim of the present study was to evaluate the usefulness of DGT for difficult biliary cannulation after unsuccessful biliary cannulation using a cannula/sphincterotome under guidance of injected contrast with P-GW (single-guidewire technique: SGT).

METHODS

One-hundred and forty-six patients with difficult biliary cannulation who underwent SGT were included in this retrospective study. DGT was carried out if SGT was unsuccessful. Pancreatic duct (PD) stenting was attempted to prevent post-ERCP pancreatitis (PEP) in all patients. The success rate of cannulation and the risk factors for PEP were investigated.

RESULTS

Biliary cannulation with SGT was achieved in 70%. DGT was carried out in 25 patients with unsuccessful SGT, biliary cannulation being successful in 72%. Of the 13 patients who underwent precut sphincterotomy, biliary cannulation was achieved in 46%. The incidence of PEP in patients who had undergone SGT, DGT, and precut sphincterotomy was 8% (12: mild, 8; moderate, 3; severe, 1), 4% (mild, 1), and 0%, respectively. PD stenting was successfully carried out in 86%. Multivariate analysis revealed unsuccessful PD stenting to be the only risk factor for PEP (OR 8.3, 95% CI 2.3-30).

CONCLUSIONS

DGT may replace SGT or become the salvage procedure in cases of unsuccessful SGT as a result of its high success rate with an acceptable incidence of PEP. Failed pancreatic duct stenting in these techniques was frequently associated with PEP.

Authors+Show Affiliations

Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article

Language

eng

PubMed ID

23937334

Citation

Ito, Kei, et al. "Clinical Usefulness of Double-guidewire Technique for Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography." Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, vol. 26, no. 3, 2014, pp. 442-9.
Ito K, Horaguchi J, Fujita N, et al. Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography. Dig Endosc. 2014;26(3):442-9.
Ito, K., Horaguchi, J., Fujita, N., Noda, Y., Kobayashi, G., Koshita, S., ... Hashimoto, S. (2014). Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography. Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society, 26(3), pp. 442-9. doi:10.1111/den.12158.
Ito K, et al. Clinical Usefulness of Double-guidewire Technique for Difficult Biliary Cannulation in Endoscopic Retrograde Cholangiopancreatography. Dig Endosc. 2014;26(3):442-9. PubMed PMID: 23937334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography. AU - Ito,Kei, AU - Horaguchi,Jun, AU - Fujita,Naotaka, AU - Noda,Yutaka, AU - Kobayashi,Go, AU - Koshita,Shinsuke, AU - Kanno,Yoshihide, AU - Ogawa,Takahisa, AU - Masu,Kaori, AU - Hashimoto,Shinichi, Y1 - 2013/08/12/ PY - 2013/02/06/received PY - 2013/07/12/accepted PY - 2013/8/14/entrez PY - 2013/8/14/pubmed PY - 2014/12/18/medline KW - biliary cannulation KW - endoscopic retrograde cholangiopancreatography (ERCP) KW - pancreatic duct stenting KW - pancreatitis KW - wire-guided cannulation SP - 442 EP - 9 JF - Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society JO - Dig Endosc VL - 26 IS - 3 N2 - BACKGROUND AND AIM: Although biliary cannulation with pancreatic guidewire placement (P-GW) is useful for difficult cases in endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of wire-guided cannulation with P-GW (double-guidewire technique: DGT) has not been clarified. The aim of the present study was to evaluate the usefulness of DGT for difficult biliary cannulation after unsuccessful biliary cannulation using a cannula/sphincterotome under guidance of injected contrast with P-GW (single-guidewire technique: SGT). METHODS: One-hundred and forty-six patients with difficult biliary cannulation who underwent SGT were included in this retrospective study. DGT was carried out if SGT was unsuccessful. Pancreatic duct (PD) stenting was attempted to prevent post-ERCP pancreatitis (PEP) in all patients. The success rate of cannulation and the risk factors for PEP were investigated. RESULTS: Biliary cannulation with SGT was achieved in 70%. DGT was carried out in 25 patients with unsuccessful SGT, biliary cannulation being successful in 72%. Of the 13 patients who underwent precut sphincterotomy, biliary cannulation was achieved in 46%. The incidence of PEP in patients who had undergone SGT, DGT, and precut sphincterotomy was 8% (12: mild, 8; moderate, 3; severe, 1), 4% (mild, 1), and 0%, respectively. PD stenting was successfully carried out in 86%. Multivariate analysis revealed unsuccessful PD stenting to be the only risk factor for PEP (OR 8.3, 95% CI 2.3-30). CONCLUSIONS: DGT may replace SGT or become the salvage procedure in cases of unsuccessful SGT as a result of its high success rate with an acceptable incidence of PEP. Failed pancreatic duct stenting in these techniques was frequently associated with PEP. SN - 1443-1661 UR - https://www.unboundmedicine.com/medline/citation/23937334/Clinical_usefulness_of_double_guidewire_technique_for_difficult_biliary_cannulation_in_endoscopic_retrograde_cholangiopancreatography_ L2 - https://doi.org/10.1111/den.12158 DB - PRIME DP - Unbound Medicine ER -