Comparative efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network...

Area of Science:

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

Background:

• Difficult biliary cannulation during ERCP presents a clinical challenge.
• Various adjunctive techniques have been developed to improve cannulation success.
• Comparative efficacy of these techniques requires rigorous evaluation.

Purpose of the Study:

• To compare the efficacy of different strategies for difficult biliary cannulation in ERCP.
• To assess success rates and post-ERCP pancreatitis (PEP) incidence across various techniques.
• To provide evidence-based recommendations for challenging ERCP procedures.

Main Methods:

• Network meta-analysis of 17 randomized controlled trials involving 2015 patients.
• Comparison of needle-knife techniques, pancreatic guidewire-assisted, pancreatic-assisted, and transpancreatic sphincterotomy against standard cannulation.
• Evaluation of biliary cannulation success and PEP incidence using pairwise and network meta-analysis.

Main Results:

• Transpancreatic sphincterotomy showed low-quality evidence for increased biliary cannulation success compared to standard techniques (RR, 1.29) and other interventions.
• Transpancreatic sphincterotomy and early needle-knife techniques were ranked highest for cannulation success.
• Early needle-knife techniques and transpancreatic sphincterotomy demonstrated reduced PEP rates compared to pancreatic guidewire-assisted technique.

Conclusions:

• Transpancreatic sphincterotomy is effective in increasing biliary cannulation success rates.
• Early needle-knife techniques and transpancreatic sphincterotomy are superior in reducing PEP rates.
• These techniques should be considered for patients experiencing difficult biliary cannulation during ERCP.