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Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
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Sequential double-guidewire technique and transpancreatic precut sphincterotomy for difficult biliary cannulation
Chang W Kim, Jae H Chang1, Tae H Kim
1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Summary
The sequential double-guidewire technique (DGT) with transpancreatic precut sphincterotomy (TPS) offers a higher success rate for difficult biliary cannulation compared to needle-knife precut papillotomy (NK). Using a pancreatic duct stent during sequential DGT-TPS significantly reduces post-ERCP pancreatitis.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Biliary Interventions
Background:
- Difficult biliary cannulation during ERCP poses a clinical challenge.
- Alternative techniques like DGT and TPS are explored for improved outcomes.
- Comparing sequential DGT-TPS with NK is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the efficacy of sequential DGT-TPS versus NK for difficult biliary cannulation.
- To compare the success rates and complication profiles of these techniques.
Main Methods:
- A retrospective analysis of 635 patients undergoing ERCP with difficult biliary cannulation.
- Standard techniques were followed by DGT or NK. TPS was used sequentially if DGT failed.
- Outcomes assessed included cannulation success and post-ERCP pancreatitis (PEP).
Main Results:
- Sequential DGT-TPS achieved a higher cannulation rate (74%) compared to NK (66%).
- Overall DGT ± TPS success rate was 85%, significantly higher than NK.
- PEP incidence was higher in DGT-TPS (37%) than NK (10%), but reduced with PD stenting (24% vs. 62%).
Conclusions:
- Sequential DGT-TPS is an effective alternative for difficult biliary cannulation.
- The use of a pancreatic duct stent during sequential DGT-TPS significantly lowers the risk of PEP.
