Transpancreatic Sphincterotomy After Double Guidewire Technique Was Noninferior to Primary Transpancreatic Sphincterotomy in Difficult Biliary Cannulation

Shaofei Wang; Bingqing Bai; Sisi Liu; Yuanyuan Fang; Chenyu Zhang; Xinwen Chen; Qiming Huang; Jiren Wang; Jianglong Hong; Yang Li; Zhangwei Xu; Xiaochang Liu; Junjun Bao; Qiao Mei; Rutao Hong

doi:10.1007/s10620-024-08319-7

Transpancreatic Sphincterotomy After Double Guidewire Technique Was Noninferior to Primary Transpancreatic Sphincterotomy in Difficult Biliary Cannulation

Dig Dis Sci. 2024 Apr 9. doi: 10.1007/s10620-024-08319-7. Online ahead of print.

Authors

Shaofei Wang^#^{1

2}, Bingqing Bai^#¹, Sisi Liu^#¹, Yuanyuan Fang¹, Chenyu Zhang¹, Xinwen Chen¹, Qiming Huang¹, Jiren Wang¹, Jianglong Hong¹, Yang Li¹, Zhangwei Xu¹, Xiaochang Liu¹, Junjun Bao³, Qiao Mei¹, Rutao Hong⁴

Affiliations

¹ Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China.
² Department of Gastroenterology, Suzhou First People's Hospital, Suzhou, 234000, Anhui Province, China.
³ Department of Endoscopy, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China.
⁴ Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China. hongrt0982@sina.com.

^# Contributed equally.

PMID: 38594433
DOI: 10.1007/s10620-024-08319-7

Abstract

Background: When unintentional pancreatic duct access occurs during difficult biliary cannulation, the double guidewire (DGW) or transpancreatic sphincterotomy (TPS) may be utilized. DGW can be easily switched to TPS due to the existing guidewire in the pancreatic duct. However, the efficacy of TPS after DGW, named sequential DGW-TPS technique, versus primary TPS has not been assessed.

Aims: Our aim was to compare the benefits and adverse events of sequential DGW-TPS technique and primary TPS.

Methods: We performed a comparative retrospective cohort study that enrolled a total of 117 patients with native papillae. The patients were divided into one of 2 groups according to the primary bile duct access technique (sequential DGW-TPS or primary TPS), both with pancreatic stenting.

Results: Between November 2017 and May 2023, a total of 84 patients were grouped into sequential DGW-TPS and 33 into primary TPS. The overall post-ERCP pancreatitis (PEP) rate was 4.3% in the entire cohort, with no statistical differences were observed between the groups in terms of PEP rates (P = 0.927), PEP severity (P = 1.000), first biliary cannulation success (P = 0.621), overall cannulation success (P = 1.000), hyperamylasemia incidence (P = 0.241), elevated amylase levels (P = 0.881), and postoperative hospital stay (P = 0.185). Furthermore, these results remained consistent in multivariable regression analysis.

Conclusions: The sequential DGW-TPS technique showed a comparable safety and biliary cannulation success rate to primary TPS in difficult biliary cannulation. Given the potential long-term complications associated with TPS, DGW should be first if inadvertent pancreatic access occurs, with TPS serving as second only if DGW fails.

Keywords: Adverse effects; Catheterization; Cholangiopancreatography; Endoscopic; Endoscopic Rretrograde; Humans; Retrospective Studies; Sphincterotomy.