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Endoscopy 2022; 54(02): 120-127
DOI: 10.1055/a-1395-7485
Original article

Early double-guidewire versus repeated single-guidewire technique to facilitate selective bile duct cannulation: a randomized controlled trial

Arthur Laquière 
1   Department of Gastroenterology, Saint Joseph Hospital, Marseille, France
,
Jocelyn Privat
2   Department of Gastroenterology, Jacques Lacarin Hospital, Vichy, France
,
Jeremie Jacques
3   Department of Endoscopy and Gastroenterology, Dupuytren Hospital, Limoges, France
,
Romain Legros
3   Department of Endoscopy and Gastroenterology, Dupuytren Hospital, Limoges, France
,
Romina Urena-Campos
1   Department of Gastroenterology, Saint Joseph Hospital, Marseille, France
,
Hichem Belkhodja
4   Digestive Endoscopy Unit, University Hospital Lyon Sud, Lyon, France
,
Clément Subtil
5   Digestive Endoscopy Unit, University Hospital, Bordeaux, France
,
Leïla Kanafi
6   Department of Gastroenterology, Groupe Polyclinique Marzet-Navarre, Pau, France
,
Laurence Lecomte
1   Department of Gastroenterology, Saint Joseph Hospital, Marseille, France
,
Christian Boustière
1   Department of Gastroenterology, Saint Joseph Hospital, Marseille, France
,
Maria Katsogiannou
7   Department of Clinical Research, Saint Joseph Hospital, Marseille, France
,
David Karsenti 
8   Digestive Endoscopy Unit, Pôle Digestif Paris Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT03582540 Type of study: prospective randomized multi-center
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Abstract

Background During endoscopic retrograde cholangiopancreatography (ERCP), access to the common bile duct (CBD) can be problematic after unintentional insertion of the guidewire into the pancreatic duct. We conducted a prospective, randomized study in order to compare biliary cannulation success rates of early double-guidewire (EDG) and repeated single-guidewire (RSG) techniques in patients with inadvertent passage of the guidewire into the pancreatic duct.

Methods Patients with a native papilla were randomly assigned to either the EDG or RSG groups after unintentional insertion of the guidewire into the pancreatic duct. The primary outcome was successful selective CBD cannulation within 10 minutes. The secondary outcomes were successful final selective bile duct cannulation, time to bile duct cannulation, and frequency of post-ERCP pancreatitis (PEP).

Results 142 patients were randomized and selective bile duct cannulation was achieved in 57/68 patients (84 %) in the EDG group and in 37/74 patients (50 %) in the RSG group within 10 minutes (relative risk 1.34; 95 % confidence interval 1.08–6.18; P < 0.001). The overall final selective bile duct cannulation rate was 99.3 %. The time to access the CBD was shorter using the EDG technique (6.0 vs. 10.4 minutes; P = 0.002). Mild PEP was not observed more frequently in the EDG group than in the RSG group.

Conclusion The EDG technique significantly increased the success rate of biliary duct cannulation within 10 minutes compared with an RSG approach.

Figs. 1 s–3 s, Tables 1 s, 2 s



Publication History

Received: 06 November 2020

Accepted: 22 January 2021

Article published online:
15 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Letter to this article:

In difficult biliary cannulation, how quickly should we be reaching for the second wire?Endoscopy 2022; 54(07): 727-727
DOI: 10.1055/a-1819-6689

 

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