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Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: prospective
Harutoshi Sugiyama1, Toshio Tsuyuguchi1, Yuji Sakai1
1Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan.
Endoscopy
|October 12, 2017
Summary
Transpancreatic precut papillotomy (TPPP) offers a higher success rate for difficult biliary cannulation compared to the double-guidewire technique (DGT). Both methods show similar complication rates, including post-ERCP pancreatitis.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Biliary Interventions
Background:
- Difficult biliary cannulation and pancreatic duct cannulation are risks for post-ERCP pancreatitis.
- Transpancreatic precut papillotomy (TPPP) and double-guidewire technique (DGT) are used for challenging cases.
Purpose of the Study:
- To compare the success and complication rates of TPPP versus DGT.
- To evaluate these techniques when prophylactic pancreatic stenting is employed.
Main Methods:
- Prospective randomized trial with 68 patients experiencing difficult biliary cannulation.
- Patients were allocated to either TPPP (34) or DGT (34) groups.
- Success and complication rates were assessed for both groups.
Main Results:
- TPPP demonstrated a significantly higher success rate (94.1%) compared to DGT (58.8%).
- Post-ERCP pancreatitis occurred in 2.9% of patients in both groups.
- No significant difference in overall cannulation-related complications was observed.
Conclusions:
- TPPP is a more successful approach than DGT for difficult biliary cannulation.
- TPPP should be considered as a primary option when initial biliary cannulation is challenging.
