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- Title
Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: Results of a retrospective study with historical controls comparing two therapeutic sequential strategies.
- Authors
Laquiere, Arthur; Desilets, Etienne; Belle, Arthur; Castellani, Paul; Grandval, Philippe; Laugier, René; Penaranda, Guillaume; Lecomte, Laurence; Boustiere, Christian
- Abstract
Background and Aim Endoscopic access to the common bile duct ( CBD) remains difficult in 10% of cases, requiring alternative techniques .CBD access was difficult after either five unsuccessful attempts, five unintentional insertions into the pancreatic duct or >10-min-long unsuccessful attempts. This retrospective study with historical controls aimed to evaluate the benefit of the double guidewire ( DGW) technique after failure of standard CBD cannulation. Methods From January 2012 to December 2014, all patients requiring therapeutic endoscopic retrograde cholangiopancreatography ( ERCP) with difficult access to CBD were included in a Studied group. This group was compared to a historical ERCP control group from January 2009 to December 2011. In the Studied group, a sequential strategy including DGW technique was done when the guidewire was unintentionally passed into the pancreatic duct. In the control group, only pre-cut technique was used. Results Among the 538 patients with naive papilla eligible for ERCP, 73 had difficult CBD access. Successful CBD access rate was higher in the Studied group: 91% (50/55) versus 67% (12/18) P = 0.0215. Complication rates were similar in both groups: 28% versus 20%, P = 0.5207. LOS was shorter in the Studied group (9.2 ± 8.5 vs 14.4 ± 7.4 days, P = 0.0028). Post- ERCP cholangitis were lower in the Studied group: 2% (1/55) versus 22% (4/18), P = 0.0118. Conclusion After standard cannulation failure, DGW technique increased successful CBD access rate and decreased LOS without increasing complications.
- Subjects
ENDOSCOPY; CATHETERIZATION; ENDOSCOPIC retrograde cholangiopancreatography; BILIARY tract radiography; PANCREATIC duct radiography
- Publication
Digestive Endoscopy, 2017, Vol 29, Issue 2, p182
- ISSN
0915-5635
- Publication type
Article
- DOI
10.1111/den.12740