Brief Article
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World J Gastroenterol. Jan 7, 2013; 19(1): 108-114
Published online Jan 7, 2013. doi: 10.3748/wjg.v19.i1.108
Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation
Young Wook Yoo, Sang-Woo Cha, Woong Cheul Lee, Sae Hee Kim, Anna Kim, Young Deok Cho
Young Wook Yoo, Department of Internal Medicine, Gastroenterology and Hepatobiliary Center, Cheongju St. Mary’s Hospital, Cheongju 360-568, South Korea
Sang-Woo Cha, Woong Cheul Lee, Young Deok Cho, Department of Internal Medicine, Soonchunhyang University College of Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University Hospital, Seoul 140-743, South Korea
Sae Hee Kim, Anna Kim, Division of Gastroenterology, Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon 302-799, South Korea
Author contributions: Yoo YW drafted of the article, analysis and interpretation of the data; Cha SW made the conception and design, analysis and interpretation of the data, critical revision of the article for important intellectual content and final approval of the article; Lee WC provided analytical tools and involved in editing the manuscript; Kim SH filled up the data; Kim A supplemented inadequate contents; Cho YD supplemented inadequate contents.
Supported by Basic Science Research Program through the National Research Foundation of Korea, the Ministry of Education, Science and Technology, No. 2011-0008901; and Research Program of Clinical Professor Research committee of Myongji Hospital, No. 20120106
Correspondence to: Sang-Woo Cha, MD, PhD, Associate Professor of Internal Medicine, Department of Internal Medicine, Soonchunhyang University College of Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchun- hyang University Hospital 59, Daesagwan-ro, Younsan-gu, Seoul 140-743, South Korea. swcha@schmc.ac.kr
Telephone: +82-2-7099202 Fax: +82-2-7099696
Received: June 6, 2012
Revised: November 14, 2012
Accepted: November 24, 2012
Published online: January 7, 2013
Abstract

AIM: To compare the outcomes between double-guidewire technique (DGT) and transpancreatic precut sphincterotomy (TPS) in patients with difficult biliary cannulation.

METHODS: This was a prospective, randomized study conducted in single tertiary referral hospital in Korea. Between January 2005 and September 2010. A total of 71 patients, who bile duct cannulation was not possible and selective pancreatic duct cannulation was achieved, were randomized into DGT (n = 34) and TPS (n = 37) groups. DGT or TPS was done for selective biliary cannulation. We measured the technical success rates of biliary cannulation, median cannulation time, and procedure related complications.

RESULTS: The distribution of patients after randomization was balanced, and both groups were comparable in baseline characteristics, except the higher percentage of endoscopic nasobiliary drainage in the DGT group (55.9% vs 13.5%, P < 0.001). Successful cannulation rate and mean cannulation times in DGT and TPS groups were 91.2% vs 91.9% and 14.1 ± 13.2 min vs 15.4 ± 17.9 min, P = 0.732, respectively. There was no significant difference between the two groups. The overall incidence of post- endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis was 38.2% vs 10.8%, P < 0.011 in the DGT group and the TPS group; post-procedure pancreatitis was significantly higher in the DGT group. But the overall incidence of post-ERCP hyperamylasemia was no significant difference between the two groups; DGT group vs TPS group: 14.7% vs 16.2%, P < 1.0.

CONCLUSION: When free bile duct cannulation was difficult and selective pancreatic duct cannulation was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However, post-procedure pancreatitis was significantly higher in the DGT group.

Keywords: Endoscopic retrograde cholangiopancreatography, Post-endoscopic retrograde cholangiopancreatography pancreatitis, Duoble guidewire technique, Transpancrestic precut sphincterotomy