Clin Endosc.  2024 Mar;57(2):226-236. 10.5946/ce.2023.128.

Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla

• Jeong HT
• Bae JH
• Kim HG
• Han J

• KMID: 2553760
• DOI: http://doi.org/10.5946/ce.2023.128

Abstract

Background/Aims
This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations.
Methods
A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups.
Results
A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of <50 years (odds ratio [OR], 9.305; 95% confidence interval [CI], 1.367–63.358; p=0.023) and hyperlipidemia (OR, 7.384; 95% CI, 1.103–49.424; p=0.039) were significant risk factors for PEP in the DGT group.
Conclusions
DGT did not increase the PEP rate in patients with naïve papilla. In addition, the age of <50 years and hyperlipidemia were significant risk factors for PEP in the DGT group.

Keyword

Ampulla of Vater; Bile Ducts; Endoscopic retrograde cholangiopancreatography; Guidewire; Pancreatitis

Figure

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  Fig. 1. Flowchart of the study population. ERCP, endoscopic retrograde cholangiopancreatography; SGT, single-guidewire technique; DGT, double-guidewire technique.

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  Fig. 2. Endoscopic and radiologic images of the single-guidewire technique. (A) Selective biliary cannulation is attempted using a sphincterotome. (B) Successful biliary cannulation is achieved (arrowhead).

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  Fig. 3. Endoscopic and radiologic images of the double-guidewire technique. (A) The papilla is fixed by a guidewire, and selective biliary cannulation is attempted using a sphincterotome. (B) A guidewire is placed in the pancreatic duct (arrow), and successful biliary cannulation is achieved (arrowhead).

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