Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

Xinopoulos, Dimitrios; Bassioukas, Stefanos P.; Kypreos, Dimitrios; Korkolis, Dimitrios; Scorilas, Andreas; Mavridis, Konstantinos; Dimitroulopoulos, Dimitrios; Paraskevas, E.

doi:10.3748/wjg.v17.i15.1989

Cited by 27 publications

(33 citation statements)

References 27 publications

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“…It stabilizes the papilla, closes the pancreatic duct and guides the second guidewire into the biliary axis by straightening the axis. 15,22,23 Other studies showed a success rate of 80-90% 13,14,16,20 at least equal to the pre-cut techniques. The DGW technique allows catheterization of the CBD in 45-90% of patients after failure of the standard technique.…”

Section: Discussionmentioning

confidence: 93%

“…24,25 Some studies showed that insertion of a guidewire and/or contrast medium injection into the pancreatic duct significantly increased the risk of PEP, [12][13][14] whereas other studies showed no significant link. 24,25 Some studies showed that insertion of a guidewire and/or contrast medium injection into the pancreatic duct significantly increased the risk of PEP, [12][13][14] whereas other studies showed no significant link.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-cut techniques (papillotomy, infundibulotomy, trans-pancreatic sphincterotomy [TPS]) 3,4,7 or techniques using pancreatic duct access (double guidewire, pancreatic prosthesis), 8,9 have demonstrated their effectiveness in CBD access. [12][13][14] Few studies evaluated DGW in a standardized strategy of CBD cannulation. 10 The double guidewire (DGW) endoscopic technique originally described by Dumonceau et al 11 showed contradictory results both in efficiency and safety.…”

Section: Introductionmentioning

confidence: 99%

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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

Laquière

Désilets

Belle

et al. 2016

Digestive Endoscopy

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Désilets

Belle

et al. 2016

Digestive Endoscopy

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“…In addition, there is a small possibility of not inserting a pancreatic stent, which is per se associated with an increase in the PEP rate [28]. A study involving 146 patients in whom pancreatic stenting was attempted after PGW-assisted cannulation reported an unsuccessful rate of 14%; the rate of pancreatitis was 4.2% in the stent group versus 29% in the group in which it was not possible to insert a stent [29]. …”

Section: Discussionmentioning

confidence: 99%

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Lopes

Canena

2018

GE Port J Gastroenterol

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Background/Aims: Recently the European Society of Gastrointestinal Endoscopy delivered guidelines on the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) and on the papillary cannulation and sphincterotomy techniques at endoscopic retrograde cholangiopancreatography (ERCP). There are no data concerning current practices in Portugal. The aim of this study was to capture practice patterns of Portuguese pancreaticobiliary endoscopists with special interest in the prevention of PEP and cannulation techniques. Methods: A written survey was distributed to all pancreaticobiliary endoscopists attending the first Portuguese meeting dedicated to ERCP in November 2016. The main outcome measures were: technique used for standard biliary cannulation, use of nonsteroidal anti-inflammatory drugs (NSAIDs) in PEP, attempting prophylactic pancreatic stenting after using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation was difficult, and use of precut as the first rescue technique when biliary cannulation was difficult. Results: Completed surveys were collected from 28 of the 32 pancreatobiliary endoscopists attending the meeting (answer rate 87.5%). Biliary cannulation was performed using a guidewire access technique by the majority (77%), usually with a sphincterotome. When cannulation was unsuccessful, precut was the first choice for 70%. NSAIDs were administered routinely for PEP by only 54%; PGW-assisted biliary cannulation was the first choice after failed standard cannulation for a minority of them, and only 27% reported to routinely attempt insertion of a pancreatic stent. High-volume endoscopists (> 150/year) tended to use NSAIDs and to insert a stent in PGW-assisted cannulation less often than low-volume-endoscopists (50 vs. 83.3%, p < 0.01, and 40 vs. 100%, p < 0.01, respectively). Precut was started without prior formal training by more than half of the endoscopists. Conclusions: There is a pronounced discrepancy between evidence-based guidelines and current clinical practice. This discrepancy is more pronounced in PEP prophylaxis, especially among high-volume endoscopists. Some advanced techniques in ERCP are initiated unsupervised, without any previous formal training. Key Message: There is a significant gap between guidelines and routine clinical practice.

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“…However, another RCT showed a higher rate of PEP in patients undergoing DGT as opposed to SGT (17% vs. 8%) 27. On the other hand, a retrospective study did not show a significant difference in the rate of PEP between the two techniques (5.3% vs. 6.1%) 28. In an RCT, the incidence of PEP was lower in a 5-Fr pancreatic stent (PS) placement group than in a non-PS placement group after DGT (2.9% vs. 23%) 29.…”

Section: Specific Endoscopic Techniquesmentioning

confidence: 93%

Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique

Song

Kang

2014

Clin Endosc

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Pancreatitis is the most frequent and distressing complication of endoscopic retrograde cholangiopancreatography (ERCP). Many recent studies have reported the use of pharmacological agents to reduce post-ERCP pancreatitis (PEP); however, the most effective agents have not been established. Reduction in the incidence of PEP in high-risk patients has been reported through specific cannulation techniques such as guide wire-assisted cannulation and the use of pancreatic stents. The present review focuses on ERCP techniques for the prevention of PEP.

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Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP

Abstract: Although DGT success rate proved not to be superior to SGT or pre-cut papillotomy, it is considered highly satisfactory in terms of safety in order to avoid the risk of a pre-cut when biliary therapy is necessary in difficult-to-cannulate cases.

Cited by 27 publications

References 27 publications

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

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

ERCP in Portugal: A Wide Survey on the Prevention of Post-ERCP Pancreatitis and Papillary Cannulation Techniques

Prevention of Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: The Endoscopic Technique

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