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Clinical usefulness of double‐guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography
- Source :
- Digestive Endoscopy. 26:442-449
- Publication Year :
- 2013
- Publisher :
- Wiley, 2013.
-
Abstract
- Background and Aim Although biliary cannulation with pancreatic guidewire placement (P-GW) is useful for difficult cases in endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of wire-guided cannulation with P-GW (double-guidewire technique: DGT) has not been clarified. The aim of the present study was to evaluate the usefulness of DGT for difficult biliary cannulation after unsuccessful biliary cannulation using a cannula/sphincterotome under guidance of injected contrast with P-GW (single-guidewire technique: SGT). Methods One-hundred and forty-six patients with difficult biliary cannulation who underwent SGT were included in this retrospective study. DGT was carried out if SGT was unsuccessful. Pancreatic duct (PD) stenting was attempted to prevent post-ERCP pancreatitis (PEP) in all patients. The success rate of cannulation and the risk factors for PEP were investigated. Results Biliary cannulation with SGT was achieved in 70%. DGT was carried out in 25 patients with unsuccessful SGT, biliarycannulation being successful in 72%. Of the 13 patients who underwent precut sphincterotomy, biliary cannulation was achieved in 46%. The incidence of PEP in patients who had undergone SGT, DGT, and precut sphincterotomy was 8% (12: mild, 8; moderate, 3; severe, 1), 4% (mild, 1), and 0%, respectively. PD stenting was successfully carried out in 86%. Multivariate analysis revealed unsuccessful PD stenting to be the only risk factor for PEP (OR 8.3, 95% CI 2.3–30). Conclusions DGT may replace SGT or become the salvage procedure in cases of unsuccessful SGT as a result of its high success rate with an acceptable incidence of PEP. Failed pancreatic duct stenting in these techniques was frequently associated with PEP.
- Subjects :
- Adult
Male
Ampulla of Vater
medicine.medical_specialty
Catheters
Risk Assessment
Precut sphincterotomy
Statistics, Nonparametric
Catheterization
Cohort Studies
Sphincterotomy, Endoscopic
Japan
medicine
Humans
Radiology, Nuclear Medicine and imaging
In patient
Clinical significance
Aged
Retrospective Studies
Aged, 80 and over
Cholangiopancreatography, Endoscopic Retrograde
Pancreatic duct
Analysis of Variance
Cholestasis
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
business.industry
Pancreatic Ducts
Gastroenterology
Retrospective cohort study
Middle Aged
medicine.disease
Cannula
Surgery
Logistic Models
Treatment Outcome
medicine.anatomical_structure
Pancreatitis
Multivariate Analysis
Female
Stents
Patient Safety
Radiology
business
Subjects
Details
- ISSN :
- 14431661 and 09155635
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Digestive Endoscopy
- Accession number :
- edsair.doi.dedup.....22e66b561185fd837d78efa0126da985