Endoscopy 2018; 50(01): 33-39
DOI: 10.1055/s-0043-118000
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: prospective randomized study

Harutoshi Sugiyama
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Toshio Tsuyuguchi
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Yuji Sakai
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Rintaro Mikata
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Shin Yasui
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Yuto Watanabe
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Dai Sakamoto
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Masato Nakamura
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
,
Takao Nishikawa
Department of Gastroenterology, Graduate School of Medicine, Chiba University, Japan
› Author Affiliations
TRIAL REGISTRATION: Prospective randomized study UMIN 000008200 at http://www.umin.ac.jp
Further Information

Publication History

submitted 09 February 2017

accepted after revision 26 June 2017

Publication Date:
11 October 2017 (online)

Abstract

Background and study aims Difficult biliary cannulation and unintentional pancreatic duct cannulation are thought to be important contributors to pancreatitis occurring after endoscopic retrograde cholangiopancreatography. Our aim was to compare and evaluate the rates of success and complications of transpancreatic precut papillotomy (TPPP) and the double-guidewire technique (DGT), both with prophylactic pancreatic stenting.

Patients and methods From April 2011 to March 2014, patients with difficult biliary cannulation, in whom we planned to first position a guidewire in the pancreatic duct, were enrolled, and 68 patients were prospectively randomly allocated to two groups (TPPP 34, DGT 34). We evaluated the rates of success and complications for each group.

Results TPPP had a significantly higher success rate (94.1 %) than DGT (58.8 %). The rate of post-ERCP pancreatitis was 2.9 % in both groups. There was no significant difference between the two groups in the overall rate of complications related to cannulation.

Conclusion If biliary cannulation cannot be achieved, TPPP should be selected first after unintentional pancreatic duct cannulation.

 
  • References

  • 1 Testoni PA, Testoni S, Giussani A. et al. Difficult biliary cannulation during ERCP: how to facilitate biliary access and minimize the risk of post-ERCP pancreatitis. Dig Liver Dis 2011; 43: 596-603
  • 2 Park SY, Park CH, Cho SB. et al. What is appropriate procedure for preoperative biliary drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy?. Surg Laparosc Endosc Percutan Tech 2011; 21: 344-348
  • 3 Bailey AA, Bourke MJ, Williams SJ. et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis. Endoscopy 2008; 40: 296-301
  • 4 Cotton PB, Lehman G, Vennes J. et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
  • 5 Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 1998; 30: S80
  • 6 Herreros de Tejada A, Calleja JL, Díaz G. et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009; 70: 700-709
  • 7 Sasahira N, Kawakami H, Isayama H. et al. Early use of double-guidewire technique to facilitate selective bile duct cannulation: the multicenter randomized controlled EDUCATION trial. Endoscopy 2015; 47: 421-429
  • 8 Sakai Y, Tsuyuguchi T, Mikata R. et al. Pancreatic duct guidewire-indwelling method for patients resistant to selective biliary cannulation and usefulness of pre-cut papillotomy following unsuccessful biliary cannulation with pancreatic duct guidewire-indwelling method. Hepatogastroenterology 2011; 58: 698-704
  • 9 Weber A, Roesch T, Pointner S. et al. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: a safe and successful technique. Pancreas 2008; 36: 187-191
  • 10 Ito K, Fujita N, Noda Y. et al. Can pancreatic duct stenting prevent post-ERCP pancreatitis in patients who undergo pancreatic duct guidewire placement for achieving selective bile duct cannulation? A prospective randomized controlled trial. J Gastroenterol 2010; 45: 1183-1191
  • 11 Fleiss JL, Tytun A, Ury SHK. A simple approximation for calculating sample sizes for comparing independent proportions. Biometrics 1980; 36: 343-346
  • 12 Halttunen J, Meisner S, Aabakken L. et al. Difficult cannulation as defined by a prospective study of the Scandinavian Association for Digestive Endoscopy (SADE) in 907 ERCPs. Scand J Gastroenterol 2014; 49: 752-758
  • 13 Vandervoort J, Soetikno RM, Tham TC. et al. Risk factors for complications after performance of ERCP. Gastrointest Endosc 2002; 56: 652-656
  • 14 Liao WC, Angsuwatcharakon P, Isayama H. et al. International consensus recommendations for difficult biliary access. Gastrointest Endosc 2017; 85: 295-304
  • 15 Cha SW, Leung WD, Lehman GA. et al. Does leaving a main pancreatic duct stent in place reduce the incidence of precut biliary sphincterotomy-associated pancreatitis? A randomized, prospective study. Gastrointest Endosc 2013; 77: 209-216
  • 16 Angsuwatcharakon P, Rerknimitr R, Ridtitid W. et al. Success rate and cannulation time between precut sphincterotomy and double-guidewire technique in truly difficult biliary cannulation. J Gastroenterol Hepatol 2012; 27: 356-361
  • 17 Lee YJ, Park YK, Lee MJ. et al. Different strategies for transpancreatic septotomy and needle knife infundibulotomy due to the presence of unintended pancreatic cannulation in difficult biliary cannulation. Gut Liver 2015; 9: 534-539
  • 18 Herreros de Tejada A, Calleja JL, Díaz G. et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009; 70: 700-709
  • 19 Yoo YW, Cha SW, Lee WC. et al. Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation. World J Gastroenterol 2013; 19: 108-114
  • 20 Ito K, Fujita N, Kanno A. et al. Risk factors for post-ERCP pancreatitis in high risk patients who have undergone prophylactic pancreatic duct stenting: a multicenter retrospective study. Intern Med 2011; 50: 2927-2932
  • 21 Kawaguchi Y, Ogawa M, Omata F. et al. Randomized controlled trial of pancreatic stenting to prevent pancreatitis after endoscopic retrograde cholangiopancreatography. World J Gastroenterol 2012; 18: 1635-1641
  • 22 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-683
  • 23 Hattunen J, Keränen I, Udd M. et al. Pancreatic sphincterotomy versus needle knife precut in difficult biliary cannulation. Surg Endosc 2009; 23: 745-749
  • 24 Testoni PA, Mariani A, Aabakken L. et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2016; 48: 657-683
  • 25 Tse F, Yuan Y, Moayyedi P. et al. Guide wire-assisted cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 2013; 45: 605-618
  • 26 Zang J, Zhang C, Gao J. Guidewire-assisted transpancreatic sphincterotomy for difficult biliary cannulation: a prospective randomized controlled trial. Surg Laparosc Endosc Percutan Tech 2014; 24: 429-433
  • 27 Akaraviputh T, Lohsiriwat V, Swangsri J. et al. The learning curve for safety and success of precut sphincterotomy for therapeutic ERCP: a single endoscopist’s experience. Endoscopy 2008; 40: 513-516
  • 28 Sundaralingam P, Masson P, Bourke MJ. Early precut sphincterotomy does not increase risk during endoscopic retrograde cholangiopancreatography in patients with difficult biliary access: a meta-analysis of randomized controlled trials. Clin Gastroenterol Hepatol 2015; 13: 1722-1729
  • 29 Lopes L, Dinis-Ribeiro M, Rolanda C. Early precut fistulotomy for biliary access: Time to change the paradigm of “the later, the better”?. Gastrointest Endosc 2014; 80: 634-641
  • 30 Kubota K, Sato T, Kato S. et al. Needle-knife precut papillotomy with a small incision over a pancreatic stent improves the success rate and reduces the complication rate in difficult biliary cannulations. J Hepatobiliary Pancreat Sci 2013; 20: 382-388