Pancreatic duct guidewire pre-occupying for difficult biliary cannulation in ERCP
10.3760/cma.j.issn.1007-5232.2013.11.006
- VernacularTitle:胰管导丝占据法在困难内镜逆行胰胆管造影中的应用价值
- Author:
Xiaoming YANG
;
Yamin PAN
;
Shuzhi WANG
;
Daojian GAO
;
Tiantian WANG
;
Bing HU
- Publication Type:Journal Article
- Keywords:
Cholangiopancreatography,endoscopic retrograde;
Sphincterotomy,endoscopic;
Postoperative complications
- From:
Chinese Journal of Digestive Endoscopy
2013;30(11):618-620
- CountryChina
- Language:Chinese
-
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 unintentional 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-guidewire technique (54.8％,P ＜0.001),pre-cut failed double-guidewire technique (81.3％,P ＜0.001) or precut 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 significant 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 perforation 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 singleguidewire 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 difficult-to-cannulate cases.
