Comparison between double-guidewire technique and transpancreatic sphincterotomy technique for difficult biliary...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Biliary Interventions

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for diagnosing and treating biliary and pancreatic duct diseases.
• Difficult biliary cannulation during ERCP can lead to procedure failure and increased complications.
• Comparing novel techniques like DWT with established methods like TPS is essential for optimizing ERCP outcomes.

Purpose of the Study:

• To compare the effectiveness and complication rates of the double-guidewire technique (DWT) versus transpancreatic sphincterotomy (TPS) for difficult biliary cannulation during ERCP.
• To evaluate key performance indicators including cannulation success rates, procedure time, and adverse events.
• To determine the optimal technique for challenging ERCP cases.

Main Methods:

• A retrospective analysis of 279 consecutive therapeutic ERCP procedures involving difficult cannulation between January 2013 and December 2014.
• Patients were divided into two groups: 137 procedures using DWT and 142 procedures using TPS.
• Outcomes including first-attempt and final cannulation success rates, cannulation time, and adverse events were compared between the DWT and TPS groups.

Main Results:

• The transpancreatic sphincterotomy (TPS) group demonstrated a significantly higher first-attempt cannulation success rate (81.0%) compared to the double-guidewire technique (DWT) group (62.0%) (P=0.00).
• Overall successful cannulation rates were comparable between DWT (86.9%) and TPS (90.8%) (P=0.09).
• Cannulation time was significantly longer in the DWT group (7.8 min) versus the TPS group (3.7 min) (P=0.00). The overall adverse event rate was lower in the DWT group (2.19%) compared to the TPS group (7.04%) (P=0.04).

Conclusions:

• Both DWT and TPS are safe and effective techniques for ERCP.
• While TPS offers a higher initial cannulation success rate, DWT is associated with fewer adverse events.
• DWT may be the preferred technique for patients with failed standard cannulation due to its lower complication rate, despite a longer procedure time.