Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: Results of a retrospective study with historical controls comparing two therapeutic sequential strategies

Laquière, A.; Désilets, Étienne; Belle, Arthur; Castellani, Paul; Grandval, Philippe; Laugier, R.; Pénaranda, Guillaume; Lecomte, Laurence; Boustière, Christian

doi:10.1111/den.12740

Cited by 11 publications

(7 citation statements)

References 31 publications

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“…Acute pancreatitis was defined as typical abdominal pain and serum concentration of lipase (required) and amylase (optional) ≥threefold the upper limit of normal that required >1 night of hospitalization. Conventionally accepted risk factors for PEP were documented with difficult cannulation defined as: (i) attempted cannulation taking >5 min; (ii) >5 attempts (touches of the papilla) to cannulate; (iii) >2 inadvertent pancreatic wire cannulations; and/or (iv) inadvertent pancreatic duct contrast injection.…”

Section: Methodsmentioning

confidence: 99%

Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry

Sahar

Ross

Lakhtakia

et al. 2019

Digestive Endoscopy

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Background and Aim Pancreatic plastic stents (PPS) can reduce the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Prospective multicenter documentation of PEP rate after PPS placement is scarce. A new 4‐Fr stent designed to be deployed over a 0.035‐inch guidewire was used to assess the effectiveness of PEP prophylaxis. Methods High‐PEP‐risk patients received a 4‐Fr PPS for primary or secondary prophylaxis at seven centers in four countries. Patients were followed until spontaneous PPS migration, endoscopic stent removal, or for 4 months, whichever came first. Main outcome was PEP rate. Results One hundred six (106) patients received PPS for PEP prophylaxis [61 (58%) primary, 45 (42%) secondary prophylaxis]. Median age was 54 years. Eighty‐one (76%) PPS were placed using a 0.035‐inch guidewire. By investigator choice 99 (93%) stents were single pigtail. Median stent length was 8 cm (range 3–12 cm). Technical success achieved in 100% of cases. Two patients in the primary prophylaxis group (3%, 95% CI 0.4–11%) experienced mild/moderate PEP. Seventy‐eight PPS available for analysis underwent spontaneous migration after a median of 29 days. There were no reports of stent‐induced ductal trauma. Post‐hoc analysis of migration rate by PPS length showed no statistically significant trend. Conclusions Among high‐risk patients in the primary prophylaxis group, observed rates of PEP are low (3%, 95% CI 0.4–11%) with the use of prophylactic 4‐Fr pancreatic duct stents compatible with a 0.035‐inch guidewire. This low rate is not unequivocally due to the prophylactic stent.

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Section: Methodsmentioning

confidence: 99%

Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry

Sahar

Ross

Lakhtakia

et al. 2019

Digestive Endoscopy

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“…The guidewire inserted into the pancreatic duct facilitates biliary cannulation for several reasons: it stabilizes the papilla, closes the pancreatic duct, and guides a second guidewire into the biliary axis by straightening the axis [7,8]. In addition, the pancreatic guidewire-assisted technique allows a good estimation of biliary direction (a little more toward the left and on top) in both endoscopy and fluoroscopy [9]. Pancreatic guidewire-assisted biliary access consists of various techniques, such as double guidewire, precut endoscopic sphincterotomy over a pancreatic stent (or guidewire), and transpancreatic papillotomy.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…5 Experienced endoscopists use the double guidewire technique where a wire inadvertently placed in the pancreatic duct is left in place and then a second wire is used to facilitate biliary duct cannulation. This was compared to a historical control group where precut sphincterotomy was carried out.…”

mentioning

confidence: 99%

“…In this issue of Digestive Endoscopy, we read with interest the retrospective study of Laqui ere and colleagues where they use historical controls to evaluate the double guidewire technique in biliary cannulation. 5 Experienced endoscopists use the double guidewire technique where a wire inadvertently placed in the pancreatic duct is left in place and then a second wire is used to facilitate biliary duct cannulation. This was compared to a historical control group where precut sphincterotomy was carried out.…”

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confidence: 99%

Endoscopic retrograde cholangiopancreatography cannulation in the difficult duct: Which technique should you pull out of your bag?

Ahmed

Wilcox

2017

Digestive Endoscopy

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Golf and endoscopic retrograde cholangiopancreaticography (ERCP) share a commonality where the highs of the successes are balanced by the lows of the frustrations. ERCP cannulation is one of the most difficult maneuvers in gastrointestinal endoscopy and is a requirement for the procedure's therapeutic benefit. As such, many different techniques have been developed to facilitate cannulation. The mission of the procedure is to provide access to the biliary or pancreatic duct typically with a guidewire, which can then be used as a platform for therapeutic and diagnostic procedures. An inherent challenge in ERCP is that the operator must make use of a two-dimensional imaging surrogate through fluoroscopy and navigate the threedimensional biliary or pancreatic duct pathway. The advanced nature of this procedure lends itself to higher complication rates including post-procedure pancreatitis, bleeding, perforation and infection. Complications of ERCP have been evaluated by meta-analyses with pancreatitis reported at 3.5% of cases, bleeding at 0.3-2%, perforation <0.6% and infection <3%.1 Complications are also a function of factors associated with the patient, procedure and operator, resulting in variable susceptibility to the adverse outcomes of ERCP. 1,2Malcolm Gladwell in his book Outliers: The Story of Success suggests that 10 000 h of correctly carrying out a skill is required in order to obtain expertise.3 ERCP as a discipline is one such example, as its mastery requires the experience of over thousands of procedures. Many different techniques, equipment platforms, devices and strategies have been developed to assist ERCP cannulation.Standard cannulation techniques will involve use of a 5-7 Fr cannula or sphincterotome with either a blunt or tapered tip often with a guidewire. That wire will either be long (450 cm) or short (260 cm) with a straight or angled tip and usually 0.035 inches or 0.025 inches in diameter. The catheter would be positioned in front of Vater's ampulla and bowed to align along the biliary duct axis. Sometimes, the devices can be steered for better alignment with the papilla.The papillotome is inserted into the papillary orifice and the guidewire is advanced under fluoroscopic guidance until observed to enter the bile duct. Contrast injection is not always routinely administered prior to advancement of the guidewire into the common bile duct (CBD). Physicians will develop preferences based on their skill sets and that of their teams in order to provide the best outcome for their patients.The European Society of Gastrointestinal Endoscopy (ESGE) defines challenging biliary cannulation as five contacts with the papilla, or more than 5 min after the major ampulla has been located or after unintentional pancreatic duct cannulation or contrast injection. 4 At times, anatomy such as the shape, size or consistency of the ampulla, the position of the ampulla with a nearby diverticulum, gastrointestinal stricture or altered anatomy from prior surgery may contribute to the complexity.In this issue of ...

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Double guidewire endoscopic technique, a major evolution in endoscopic retrograde cholangiopancreatography: Results of a retrospective study with historical controls comparing two therapeutic sequential strategies

Abstract: After standard cannulation failure, DGW technique increased successful CBD access rate and decreased LOS without increasing complications.

Cited by 11 publications

References 31 publications

Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry

Reducing the risk of post‐endoscopic retrograde cholangiopancreatography pancreatitis using 4‐Fr pancreatic plastic stents placed with common‐type guidewires: Results from a prospective multinational registry

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

Endoscopic retrograde cholangiopancreatography cannulation in the difficult duct: Which technique should you pull out of your bag?

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