Abstract :
Background: Difficult bile duct cannulation is one of the main problems in endoscopic retrograde
cholangiopancreatography (ERCP). Double-guidewire (DG) cannulation technique is a promising approach for
this problem, an alternative to the well-known technique of needle-knife (NK) precut access cannulation.
Objecive: To compare the outcome of NK precut technique and DG technique in patients whom bile
duct cannulation is difficult to perform.
Patients and Methods: During a 20-months study period, 50 patients with difficult bile duct cannulation
defined by unsuccessful attempts to get into the common bile duct after 15 minutes from initial cannulation.
Twenty-five patients were assigned to each group using NK precut technique (NK group) and DG technique (DG
group). Success rate and complication rate were compared between the two groups.
Results: Successful bile duct cannulation was achieved in 18 of 25 patients (72%) in the NK group and
in 19 of 25 patients (76%) in the DG group (p = 0.747). The incidence of post-ERCP pancreatitis was 2 of 25
patients (8%) in the former group and 6 of 25 patients (24%) in the latter (p = 0.247). The incidence of bleeding
complication was 11 of 25 patients (44%) in the NK group, and zero in the DG group (p = 0.0002).
Conclusion: DG technique was not superior to NK precut technique in achieving bile duct cannulation
in patients with difficult bile duct cannulation. DG technique was associated with a higher risk of post-ERCP
pancreatitis, but significantly safer than NK precut technique with regard to bleeding complication. |
file/Thai-Journal-of-gastroenterology-vol-11-no-3-466200.pdf