Prospective Randomized Pilot Trial of Selective Biliary Cannulation Using Pancreatic Guide-Wire Placement

Background and Study Aims: In difficult cases of selective bile duct cannulation, several expanded techniques are available which have only been partially evaluated in randomized studies. This study describes a prospective, randomized trial investigating a further technique for obtaining selective biliary access - pancreatic duct wire placement.
Patients and Methods: During a 6-month study period, 107 consecutive patients required deep selective biliary cannulation. Accessing the bile duct using a catheter failed within 10 min in 53 of the patients, who were randomly assigned to either preinsertion of a guide wire into the pancreatic duct or persistence with a conventional catheter. The success rate and complication rate were compared between these two groups.
Results: In the pancreatic duct guide-wire group (n = 27), the success rate was significantly higher than in the conventional group (93 % versus 58 %). No pancreatitis complications occurred in either group.
Conclusions: Inserting a guide wire into the pancreatic duct to facilitate deep selective bile duct cannulation is better than persisting with a conventional catheter. Further studies will be needed to confirm these results and to compare this method with other sophisticated techniques for obtaining selective access to the biliary duct.

References

• 1 Kasmin F E, Cohen D, Batra S. et al . Needle-knife sphincterotomy in a tertiary referral center: efficacy and complications.  Gastrointest Endosc. 1996;  44 48-53
• 2 Mavrogiannis C, Liatsos C, Romanos A. et al . Needle-knife fistulotomy versus needle-knife precut papillotomy for the treatment of common bile duct stones.  Gastrointest Endosc. 1999;  50 334-339
• 3 Bruins Slot W, Schoeman M N, Disario J A. et al . Needle-knife sphincterotomy as a precut procedure: a retrospective evaluation of efficacy and complications.  Endoscopy. 1996;  28 334-339
• 4 Catalano M, Fazel A, Quadri A. et al . Endoscopic transpancreatic ampullary septotomy for inaccessible obstructed bile ducts: comparison with stander pre-cut sphincteretomy [abstract].  Gastrointest Endosc. 2002;  55 AB174
• 5 Hayashi H, Hosokawa O, Ohta K. et al . Validity of isosorbide dinitrate administration in endoscopic retrograde cholangiopancreatography: a prospective study [in Japanese with English abstract].  Syoukaki Naishikyou. 1999;  11 757-762
• 6 Hayashi H, Maeda S, Hosokawa O. et al . A technique for selective cannulation of the common bile duct in endoscopic retrograde cholangiopancreatography: insertion of guide wire into the pancreatic duct [in Japanese with English abstract].  Gastroenterol Endosc. 2001;  43 828-832
• 7 Dumonceau J M, Devière J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography.  Endoscopy. 1998;  30 S80
• 8 Loperfido S, Angelini G, Benedetti G. et al . Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study.  Gastrointest Endosc. 1998;  48 1-10
• 9 Freeman M L, Nelson D B, Sherman S. et al . Complication of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 909-918
• 10 Trap R, Adamsen S, Hart-Hansen O. et al . Severe and fatal complications after diagnostic and therapeutic ERCP: a prospective series of claims to insurance covering public hospitals.  Endoscopy. 1999;  31 125-130
• 11 Cotton P B, Lehman G, Sherman S. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
• 12 Igarashi Y, Tada T, Shimura J. et al . A new cannula with a flexible tip (swing tip) may improve the success rate of endoscopic retrograde cholangiopancreatography.  Endoscopy. 2002;  34 628-631