Brief Article
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World J Gastroenterol. Apr 21, 2011; 17(15): 1989-1995
Published online Apr 21, 2011. doi: 10.3748/wjg.v17.i15.1989
Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP
Dimitrios Xinopoulos, Stefanos P Bassioukas, Dimitrios Kypreos, Dimitrios Korkolis, Andreas Scorilas, Konstantinos Mavridis, Dimitrios Dimitroulopoulos, Emmanouil Paraskevas
Dimitrios Xinopoulos, Stefanos P Bassioukas, Dimitrios Kypreos, Dimitrios Dimitroulopoulos, Emmanouil Paraskevas, Gastroenterology Unit, Hellenic Anticancer Institute “Saint Savvas” Hospital of Athens, 171 Alexandras Avenue, GR 11522, Greece
Dimitrios Korkolis, First Surgical Department, Hellenic Anticancer Institute “Saint Savvas” Hospital of Athens, 171 Alexandras Avenue, GR 11522, Greece
Andreas Scorilas, Konstantinos Mavridis, Department of Biochemistry and Molecular Biology, University of Athens, University Campus Ilissia, GR 15701, Greece
Author contributions: Bassioukas SP designed the study, performed procedures and wrote the manuscript; Xinopoulos D and Kypreos D performed procedures; Korkolis D, Dimitroulopoulos D and Paraskevas E were involved in editing the manuscript; Scorilas A and Mavridis K were involved in data analysis and interpretation.
Correspondence to: Stefanos P Bassioukas, MD, Gastroenterology Unit, Hellenic Anticancer Institute “Saint Savvas” Hospital of Athens, 171 Alexandras Avenue, GR 11522, Greece. stevenbassioukas@yahoo.gr
Telephone: +30-210-6409407   Fax: +30-210-6409409
Received: November 17, 2010
Revised: December 23, 2010
Accepted: December 30, 2010
Published online: April 21, 2011
Abstract

AIM: To investigate the technical success and clinical complication rate of a cannulated pancreatic duct with guidewire for biliary access.

METHODS: During a five-year study period, a total of 2843 patients were included in this retrospective analysis. Initial biliary cannulation method consisted of single-guidewire technique (SGT) for up to 5 attempts, followed by double-guidewire technique (DGT) when repeated unintentional pancreatic duct cannulation had taken place. Pre-cut papillotomy technique was reserved for when DGT had failed or no pancreatic duct cannulation had been previously achieved. Main outcome measurements were defined as biliary cannulation success and post-endoscopic retrograde cholangiopancreatography (ERCP) complication rate.

RESULTS: SGT (92.3% success rate) was characterized by statistically significant enhanced patient outcome compared to either the DGT (43.8%, P < 0.001), pre-cut failed DGT (73%, P < 0.001) or pre-cut as first step method (80.6%, P = 0.002). Pre-cut as first step method offered a statistically significantly more favorable outcome compared to the DGT (P < 0.001). The incidence of post-ERCP pancreatitis did not differ in a statistically significant manner between either method (SGT: 5.3%, DGT: 6.1%, Pre-cut failed DGT: 7.9%, Pre-cut as first step: 7.5%) or with patients’ gender.

CONCLUSION: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Keywords: Endoscopic retrograde cholangiopancreatography; Post-endoscopic retrograde cholangiopancreatography pancreatitis; Pre-cut papillotomy; Pancreatic duct