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Endoscopy 2017; 49(01): 15-26
DOI: 10.1055/s-0042-119035
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Double-guidewire technique in difficult biliary cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis[*]

Frances Tse
1   Division of Gastroenterology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
,
Yuhong Yuan
1   Division of Gastroenterology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
,
Paul Moayyedi
1   Division of Gastroenterology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
,
Grigorios I. Leontiadis
1   Division of Gastroenterology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada
,
Alan N. Barkun
2   McGill University and McGill University Health Centre, Montreal, Quebec, Canada
› Author Affiliations
Further Information

Publication History

submitted 20 April 2016

accepted after revision 09 August 2016

Publication Date:
20 December 2016 (online)

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Abstract

Background and study aims Difficult cannulation is a risk factor for pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP). The double-guidewire technique (DGT) may improve cannulation success and reduce the risk of post-ERCP pancreatitis (PEP) in patients with difficult cannulation. This systematic review compared the DGT with persistent conventional cannulation or other advanced techniques in patients with difficult cannulation.

Patients and Methods CENTRAL, MEDLINE, EMBASE, and CINAHL databases and DDW and UEGW abstracts up to March 2016 were searched for randomized controlled trials (RCTs) comparing DGT with persistent conventional cannulation or other advanced techniques (precut, pancreatic duct [PD] stenting). The primary outcome was PEP. Secondary outcomes included severity of PEP, successful cannulation of the common bile duct (CBD) with the randomized technique, overall CBD cannulation success, and ERCP-related complications.

Results 7 RCTs (577 patients) were included. Use of the DGT significantly increased PEP compared to other endoscopic techniques (risk ratio [RR] 1.98, 95 % confidence interval [95 %CI] 1.14 – 3.42). There was no significant difference in CBD cannulation success with the randomized technique (RR 1.04, 95 %CI 0.87 – 1.24) or in overall cannulation success (RR 1.04, 95 %CI 0.91 – 1.18) between DGT and other techniques. There was also no significant difference in the risk of other ERCP-related complications (bleeding, perforation, cholangitis, and mortality). The results were robust in sensitivity analyses.

Conclusions In patients with difficult cannulation, sole use of the DGT appears to increase the risk of PEP without any superiority in achieving biliary cannulation compared to other techniques. PD stenting may reduce the risk of PEP when the DGT is used. The influence of co-intervention in the form of per-procedural nonsteroidal anti-inflammatory drug (NSAID) administration is unclear.

* This article is based on a Cochrane Review which has been recently published in the Cochrane Database of Systematic Reviews (CDSR) (Tse et al. Cochrane Database Syst Rev 2016 May 16; (5):CD010571 [1]). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review.


 

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