Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Techniques

Background:

• Difficult biliary cannulation during ERCP is linked to increased post-ERCP pancreatitis (PEP) risk.
• Advanced rescue techniques are crucial for managing challenging ERCP cases.
• Comparing transpancreatic biliary sphincterotomy (TPBS) and double-guidewire (DGW) is vital for optimizing patient outcomes.

Purpose of the Study:

• To prospectively compare the efficacy and safety of TPBS versus DGW techniques.
• To evaluate the rates of post-ERCP pancreatitis (PEP) associated with each rescue method.
• To determine the success rate of deep biliary cannulation using TPBS and DGW.

Main Methods:

• A prospective, randomized, multicenter study involving 1190 patients undergoing ERCP.
• 203 patients with difficult common bile duct cannulation were randomized to TPBS or DGW.
• Primary endpoint: PEP frequency; Secondary endpoints: successful cannulation rates.

Main Results:

• PEP occurred in 13.5% of TPBS patients and 16.2% of DGW patients (P=0.69).
• No significant difference in PEP severity was observed between the groups.
• Successful deep biliary cannulation was significantly higher with TPBS (84.6%) compared to DGW (69.7%; P=0.01).

Conclusions:

• TPBS and DGW techniques demonstrate comparable PEP rates in difficult biliary cannulation scenarios.
• TPBS offers a higher success rate for deep biliary cannulation when guidewire entry into the pancreatic duct occurs.
• TPBS is a valuable alternative for difficult ERCP cases requiring rescue cannulation strategies.