Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial.

Area of Science:

• Gastroenterology
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Biliary Endoscopy

Background:

• ERCP is associated with serious complications, with difficult common bile duct (CBD) cannulation being a key risk factor for post-ERCP pancreatitis.
• The double-guidewire technique (DGT) has emerged as a potential alternative for challenging CBD cannulation scenarios.

Purpose of the Study:

• To compare the efficacy and safety of DGT versus standard cannulation technique (SCT) in patients experiencing difficult CBD cannulation.
• To evaluate success rates, number of attempts, and ERCP-related complications between the two techniques.

Main Methods:

• A multicenter randomized controlled trial involving six tertiary referral centers.
• 188 patients with difficult CBD cannulation (≥5 unsuccessful attempts) were randomized into DGT (n=97) or SCT (n=91) groups.
• Comparison focused on CBD cannulation rate, attempts needed, and ERCP-related complications over an additional 10 attempts.

Main Results:

• Successful CBD cannulation was achieved in 47% of the DGT group versus 56% of the SCT group (OR 0.85; 95% CI, 0.64-1.12).
• The median number of attempts was 9 for DGT and 7 for SCT (P = .128).
• Post-ERCP pancreatitis occurred in 17% of the DGT group compared to 8% in the SCT group (OR 2.13; 95% CI, 0.89-5.05).

Conclusions:

• DGT was not superior to SCT in achieving CBD cannulation in patients with difficult cannulation.
• DGT may be associated with an increased risk of post-ERCP pancreatitis.
• Limitations include a reduced number of enrolled subjects and lack of detailed data on pancreatic duct contrast injections.