Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: a systematic review and meta-analysis

Abstract

Background and study aims Approximately 11 % of biliary cannulations are considered difficult. The double guidewire (DGW-T) and transpancreatic sphincterotomy (TPS) are two useful techniques when difficult cannulation exists and the main pancreatic duct is unintentionally accessed. We carried out a systematic review and meta-analysis to evaluate the effectiveness and security of both DGW-T and TPS techniques in difficult biliary cannulation.

Methods We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. Were included all RCT which showed a comparison between TPS and DGW in difficult biliary cannulation. Endpoints computed were successful cannulation rate, median cannulation time, and adverse events rate.

Results Four studies were selected (4 RCTs). These studies included 260 patients. The mean age was 64.79 ± 12.99 years. Of the patients, 53.6 % were men and 46.4 % were women. The rate of successful cannulation was 93.3 % in the TPS group and 79.4 % in the DGW-T group (P = 0.420). The rate of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) was lower in patients who had undergone TPS than DGW-T (TPS: 8.9 % vs DGW-T: 22.2 %, P = 0.02). The mean cannulation time was 14.7 ± 9.4 min in the TPS group and 15.1 ± 7.4 min with DGW-T (P = 0.349).

Conclusions TPS and DGW are two useful techniques in patients with difficult cannulation. They both have a high rate of successful cannulation; however, the PEP was higher with DGW-T than with TPS.

Publication History

Received: 13 January 2021

Accepted: 16 June 2021

Article published online:
12 November 2021

• References

• 1 DeBenedet A, Elmunzer B, McCarthy S. et al. Intraprocedural quality in endoscopic retrograde cholangiopancreatography: a meta-analysis. Am J Gastroenterol 2013; 108: 1696-1704
• 2 Testoni P, 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
• 3 Liao W, Angsuwatcharakon P, Isayama H. et al. International consensus recommendations for difficult biliary access. Gastrointest Endosc 2017; 85: 295-304
• 4 Chandrasekhara V, Khashab MA, Muthusamy VR. et al. ASGE Standards of Practice Committee. Adverse events associated with ERCP. Gastrointest Endosc 2017; 85: 32-47
• 5 Nguyen-Tang T, Dumonceau J. Double-guidewire technique for difficult bile duct cannulation: why not insert a prophylactic pancreatic stent?. Gastrointest Endosc 2010; 72: 466
• 6 Dumonceau J, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 1998; 30: S80
• 7 Herreros de Tejada A, Calleja J, Díaz G. et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized controlled trial. Gastrointest Endosc 2009; 70: 700-709
• 8 Sasahira N, Kawakami H, Isayama H. et al. Early use of double-guidewire technique to facilitate selective bile duct cannulation: the multicenter randomized controlled EDUCATION trial. Endoscopy 2015; 47: 421-429
• 9 Goff JS. Common bile duct pre-cut sphincterotomy: transpancreatic sphincter approach. Gastrointest Endosc 1995; 41: 502-506
• 10 Sakai Y, Tsuyuguchi T, Mikata R. et al. Pancreatic duct guidewire-indwelling method for patients resistant to selective biliary cannulation and usefulness of pre-cut papillotomy following unsuccessful biliary cannulation with pancreatic duct guidewire-indwelling method. Hepatogastroenterology 2011; 58: 698-704
• 11 Weber A, Roesch T, Pointner S. et al. Transpancreatic precut sphincterotomy for cannulation of inaccessible common bile duct: a safe and successful technique. Pancreas 2008; 36: 187-191
• 12 Easterbrook PJ, Berlin JA, Gopalan R. et al. Publication bias in clinical research. Lancet 1991; 337: 867-872
• 13 Mantel N, Haenszel W. Statistical aspects of the analysis of datafrom retrospective studies of disease. J Natl Cancer Inst 1959; 22: 719-748
• 14 Cha S, Kim S, Kim A. et al. DGT vs TPS in patients with initial pd cannulation by chance; prospective randomized multi-center study. Gastrointest Endosc 2012; 75: AB141
• 15 Yoo YW, Cha SW, Lee WC. Double guidewire technique vs transpancreatic precut sphincterotomy in difficult biliary cannulation. World J Gastroenterol 2013; 19: 108-114
• 16 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
• 17 Mohie E, Mohamed A, Al-Sisi M. Double guidewire technique versus transpancreatic sphincterotomy for difficult biliary cannulation. Egyptian J Hosp Med 2019; 74: 764-770
• 18 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
• 19 Maeda S, Hayashi H, Hosokawa O. et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guidewire placement. Endoscopy 2003; 35: 721-724
• 20 Herreros de Tejada A, Calleja JL, Díaz G. et al. Double guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009; 70: 700-709
• 21 Guzmán-Calderón E, Vera A, Díaz R. et al. Efficacy and complications of double guidewire technique in biliary tract cannulation. Rev Gastroenterol Peru 2017; 37: 235-239
• 22 Akashi R, Kiyozumi T, Jinnouchi K. et al. Pancreatic sphincter precutting to gain selective access to the common bile duct: a series of 172 patients. Endoscopy 2004; 36: 405-410
• 23 Kahaleh M, Tokar J, Mullick T. et al. Prospective evaluation of pancreatic sphincterotomy as a precut technique for biliary cannulation. Clin Gastroenterol Hepatol 2004; 2: 971-977