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

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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.

Graphical Abstract

A retrospective cohort study was conducted to compare the safety and efficacy of the 33 sequential DGW-TPS and 84 primary TPS techniques. No significant differences were found in PEP, cannulation success, or other AEs. Multivariable regression analysis reaffirmed these findings. The sequential DGW-TPS technique showed a comparable safety and efficacy to primary TPS, supporting its use if inadvertent pancreatic access occurs.

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Abbreviations

ERCP:

Endoscopic retrograde cholangiopancreatography

PEP:

Post-ERCP pancreatitis

AEs:

Adverse events

PD:

Pancreatic duct

DGW:

Double guidewire

TPS:

Transpancreatic sphincterotomy

SDTT:

Sequential DGW-TPS technique

PTPS:

Primary transpancreatic sphincterotomy

CBD:

Common bile duct

GI:

Gastrointestinal

OR:

Odds ratio

CI:

Confidence interval

RCT:

Randomized controlled trial

References

  1. Laquiere A, Privat J, Jacques J et al. Early double-guidewire versus repeated single-guidewire technique to facilitate selective bile duct cannulation: a randomized controlled trial. Endoscopy 2022;54:120–127. https://doi.org/10.1055/a-1395-7485.

    Article  PubMed  Google Scholar 

  2. Thiruvengadam NR, Forde KA, Ma GK et al. Rectal indomethacin reduces pancreatitis in high- and low-risk patients undergoing endoscopic retrograde cholangiopancreatography. Gastroenterology 2016;151:288–297. https://doi.org/10.1053/j.gastro.2016.04.048.

    Article  CAS  PubMed  Google Scholar 

  3. Berry R, Han JY, Tabibian JH. Difficult biliary cannulation: Historical perspective, practical updates, and guide for the endoscopist. World J Gastrointest Endosc 2019;11:5–21. https://doi.org/10.4253/wjge.v11.i1.5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jang SI, Kim DU, Cho JH et al. Primary needle-knife fistulotomy versus conventional cannulation method in a high-risk cohort of post-endoscopic retrograde cholangiopancreatography pancreatitis. Am J Gastroenterol 2020;115:616–624. https://doi.org/10.14309/ajg.0000000000000480.

    Article  PubMed  Google Scholar 

  5. Op DWM, Schirra J, Schulz C et al. Biliary cannulation in endoscopic retrograde cholangiography: how to tackle the difficult papilla. Dig Dis 2022;40:85–96. https://doi.org/10.1159/000515692.

    Article  Google Scholar 

  6. Testoni PA, Mariani A, Aabakken L et al. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48:657–683. https://doi.org/10.1055/s-0042-108641.

    Article  PubMed  Google Scholar 

  7. Huang L, Yu QS, Zhang Q et al. Comparison between double-guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation. Dig Endosc. 2015;27:381–387. https://doi.org/10.1111/den.12387.

    Article  PubMed  Google Scholar 

  8. Laquiere A, Desilets E, Belle A et al. Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: results of a retrospective study with historical controls comparing two therapeutic sequential strategies. Dig Endosc. 2017;29:182–189. https://doi.org/10.1111/den.12740.

    Article  PubMed  Google Scholar 

  9. Pin F, Conti BM, Crino SF et al. Double guide-wire technique versus transpancreatic biliary sphincterotomy for difficult biliary cannulation: Real life experience from a referral center. Dig Liver Dis. 2022;54:1548–1553. https://doi.org/10.1016/j.dld.2022.07.011.

    Article  PubMed  Google Scholar 

  10. Sundaram S, Jagtap N. Transpancreatic biliary sphincterotomy: justified or overkill? Endoscopy. 2021;53:985. https://doi.org/10.1055/a-1408-3258.

    Article  PubMed  Google Scholar 

  11. Sugiyama H, Tsuyuguchi T, Sakai Y et al. Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: prospective randomized study. Endoscopy. 2018;50:33–39. https://doi.org/10.1055/s-0043-118000.

    Article  PubMed  Google Scholar 

  12. Kylanpaa L, Koskensalo V, Saarela A et al. Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial. Endoscopy. 2021;53:1011–1019. https://doi.org/10.1055/a-1327-2025.

    Article  PubMed  Google Scholar 

  13. Facciorusso A, Ramai D, Gkolfakis P et al. Comparative efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis. Gastrointest Endosc. 2022;95:60–71. https://doi.org/10.1016/j.gie.2021.09.010.

    Article  PubMed  Google Scholar 

  14. Kylanpaa L, Koskensalo V, Udd M et al. Reply to Sundaram and Jagtap. Endoscopy. 2021;53:986. https://doi.org/10.1055/a-1408-3754.

    Article  PubMed  Google Scholar 

  15. Shi QQ, Ning XY, Zhan LL et al. Placement of prophylactic pancreatic stents to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis in high-risk patients: a meta-analysis. World J Gastroenterol. 2014;20:7040–7048. https://doi.org/10.3748/wjg.v20.i22.7040.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Choudhary A, Bechtold ML, Arif M et al. Pancreatic stents for prophylaxis against post-ERCP pancreatitis: a meta-analysis and systematic review. Gastrointest Endosc. 2011;73:275–282. https://doi.org/10.1016/j.gie.2010.10.039.

    Article  PubMed  Google Scholar 

  17. Jowell PS, Baillie J, Branch MS et al. Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med. 1996;125:983–989. https://doi.org/10.7326/0003-4819-125-12-199612150-00009.

    Article  CAS  PubMed  Google Scholar 

  18. IAP, Working Group. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:1–15. https://doi.org/10.1016/j.pan.2013.07.063.

    Article  Google Scholar 

  19. Cotton PB, Eisen GM, Aabakken L et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454. https://doi.org/10.1016/j.gie.2009.10.027.

    Article  PubMed  Google Scholar 

  20. Zou XP, Leung JW, Li YH et al. Comparison of sequential pancreatic duct guidewire placement technique and needle knife precut sphincterotomy for difficult biliary cannulation. J Dig Dis. 2015;16:741–746. https://doi.org/10.1111/1751-2980.12300.

    Article  PubMed  Google Scholar 

  21. Kim CW, Chang JH, Kim TH et al. Sequential double-guidewire technique and transpancreatic precut sphincterotomy for difficult biliary cannulation. Saudi J Gastroenterol. 2015;21:18–24. https://doi.org/10.4103/1319-3767.151212.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Elmunzer BJ. Reducing the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis. Dig Endosc. 2017;29:749–757. https://doi.org/10.1111/den.12908.

    Article  PubMed  Google Scholar 

  23. Akshintala VS, Kanthasamy K, Bhullar FA et al. Incidence, severity, and mortality of post-ERCP pancreatitis: an updated systematic review and meta-analysis of 145 randomized controlled trials. Gastrointest Endosc. 2023;98:1–6. https://doi.org/10.1016/j.gie.2023.03.023.

    Article  PubMed  Google Scholar 

  24. Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc. 1995;41:502–505. https://doi.org/10.1016/s0016-5107(05)80011-2.

    Article  CAS  PubMed  Google Scholar 

  25. Buscaglia JM, Kalloo AN. Pancreatic sphincterotomy: technique, indications, and complications. World J Gastroenterol. 2007;13:4064–4071. https://doi.org/10.3748/wjg.v13.i30.4064.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kozarek R. Flail, flay, or fail: needle-knife versus transpancreatic sphincterotomy to access the difficult-to-cannulate bile duct during ERCP. Endoscopy. 2017;49:842–843. https://doi.org/10.1055/s-0043-117045.

    Article  PubMed  Google Scholar 

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Acknowledgments

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Author notes

  1. Shaofei Wang, Bingqing Bai and Sisi Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China

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

  2. Department of Endoscopy, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, China

    Junjun Bao

  3. Department of Gastroenterology, Suzhou First People’s Hospital, Suzhou, 234000, Anhui Province, China

    Shaofei Wang

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  1. Shaofei Wang
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Contributions

RH, QM, and JB conceived and designed the study. SL, YF, CZ, XC, QH, JW, and JH acquired the data. SW analyzed and interpreted the data. SW drafted and edited the manuscript. YL, ZX, and XL critically reviewed the manuscript for important intellectual content. BQB did the statistical analysis. The authors alone are responsible for the content and the writing of the paper.

Corresponding author

Correspondence to Rutao Hong.

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Competing interests

We declare no competing interests.

Ethics approval

The research protocol has been approved by the Hospital Research Ethics Committee (No. Quick-PJ 2023–09-14).

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Wang, S., Bai, B., Liu, S. et al. Transpancreatic Sphincterotomy After Double Guidewire Technique Was Noninferior to Primary Transpancreatic Sphincterotomy in Difficult Biliary Cannulation. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08319-7

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