Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지
DOI QR코드

DOI QR Code

Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla

  • Han Taek Jeong (Department of Internal Medicine, Daegu Catholic University School of Medicine) ;
  • June Hwa Bae (Department of Internal Medicine, Daegu Catholic University School of Medicine) ;
  • Ho Gak Kim (Department of Internal Medicine, Daegu Catholic University School of Medicine) ;
  • Jimin Han (Department of Internal Medicine, Daegu Catholic University School of Medicine)
  • Received : 2023.05.13
  • Accepted : 2023.07.01
  • Published : 2024.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background/Aims: This study aimed to compare the safety of the double-guidewire technique (DGT) with that of the conventional single-guidewire technique (SGT) in real-world situations. Methods: A total of 240 patients with naïve papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP) at Daegu Catholic University Medical Center between January 2021 and December 2021 were included. The primary outcome was the rate of post-ERCP pancreatitis (PEP) in the SGT and DGT groups. Results: A total of 163 patients (67.9%) belonged to the SGT group, and 77 (32.1%) belonged to the DGT group. The rates of successful biliary cannulation were 95.7% and 83.1% in the SGT and DGT groups, respectively (p=0.002). In the study group, PEP occurred in 14 patients (5.8%). The PEP rates were not significantly different between the SGT and DGT groups (4.3% vs. 9.1%, p=0.150). In the multivariate analysis, the age of <50 years (odds ratio [OR], 9.305; 95% confidence interval [CI], 1.367-63.358; p=0.023) and hyperlipidemia (OR, 7.384; 95% CI, 1.103-49.424; p=0.039) were significant risk factors for PEP in the DGT group. Conclusions: DGT did not increase the PEP rate in patients with naïve papilla. In addition, the age of <50 years and hyperlipidemia were significant risk factors for PEP in the DGT group.

Keywords

References

  1. 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
  2. Tse F, Yuan Y, Moayyedi P, et al. Guidewire-assisted cannulation of the common bile duct for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Cochrane Database Syst Rev 2012;12:CD009662.
  3. Williams EJ, Taylor S, Fairclough P, et al. Are we meeting the standards set for endoscopy?: results of a large-scale prospective survey of endoscopic retrograde cholangio-pancreatograph practice. Gut 2007;56:821-829. https://doi.org/10.1136/gut.2006.097543
  4. Dumonceau JM, Deviere J, Cremer M. A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 1998;30:S80.
  5. Maeda S, Hayashi H, Hosokawa O, et al. Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy 2003;35:721-724. https://doi.org/10.1055/s-2003-41576
  6. Tse F, Yuan Y, Moayyedi P, et al. Double-guidewire technique in difficult biliary cannulation for the prevention of post-ERCP pancreatitis: a systematic review and meta-analysis. Endoscopy 2017;49:15-26.
  7. Takenaka M, Kudo M. Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases. Clin Endosc 2022;55:605-614. https://doi.org/10.5946/ce.2022.032
  8. 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
  9. 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
  10. Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991;37:383-393. https://doi.org/10.1016/S0016-5107(91)70740-2
  11. Fugazza A, Troncone E, Amato A, et al. Difficult biliary cannulation in patients with distal malignant biliary obstruction: an underestimated problem? Dig Liver Dis 2022;54:529-536. https://doi.org/10.1016/j.dld.2021.07.010
  12. Lee ES, Kim H. The prevention and management of post-ERCP pancreatitis. Korean J Pancreas Biliary Tract 2016;21:68-75. https://doi.org/10.15279/kpba.2016.21.2.68
  13. Wu CC, Lim SJ, Khor CJ. Endoscopic retrograde cholangiopancreatography-related complications: risk stratification, prevention, and management. Clin Endosc 2023;56:433-445. https://doi.org/10.5946/ce.2023.013
  14. Sadeghi A, Jafari-Moghaddam R, Ataei S, et al. Role of vitamin C and rectal indomethacin in preventing and alleviating post-endoscopic retrograde cholangiopancreatography pancreatitis: a clinical study. Clin Endosc 2023;56:214-220. https://doi.org/10.5946/ce.2022.165
  15. Arata S, Takada T, Hirata K, et al. Post-ERCP pancreatitis. J Hepatobiliary Pancreat Sci 2010;17:70-78. https://doi.org/10.1007/s00534-009-0220-5
  16. Dumonceau JM, Andriulli A, Deviere J, et al. European Society of Gastrointestinal Endoscopy (ESGE) guideline: prophylaxis of post-ERCP pancreatitis. Endoscopy 2010;42:503-515. https://doi.org/10.1055/s-0029-1244208
  17. Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: pathophysiology, early identification and risk stratification. Adv Clin Exp Med 2018;27:149-154. https://doi.org/10.17219/acem/66773
  18. Herreros de Tejada A, Calleja JL, Diaz G, et al. Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 2009;70:700-709. https://doi.org/10.1016/j.gie.2009.03.031
  19. Yang MJ, Hwang JC, Yoo BM, et al. Wire-guided cannulation over a pancreatic stent versus double guidewire technique in patients with difficult biliary cannulation. BMC Gastroenterol 2015;15:150.
  20. Dumonceau JM, Andriulli A, Elmunzer BJ, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline: updated June 2014. Endoscopy 2014;46:799-815. https://doi.org/10.1055/s-0034-1377875
  21. Karr S. Epidemiology and management of hyperlipidemia. Am J Manag Care 2017;23(9 Suppl):S139-S148.
  22. Deng LH, Xue P, Xia Q, et al. Effect of admission hypertriglyceridemia on the episodes of severe acute pancreatitis. World J Gastroenterol 2008;14:4558-4561. https://doi.org/10.3748/wjg.14.4558
  23. Sbeit W, Khoury T. Fatty pancreas represents a risk factor for acute pancreatitis: a pilot study. Pancreas 2021;50:990-993. https://doi.org/10.1097/MPA.0000000000001867
  24. Hong W, Zimmer V, Basharat Z, et al. Association of total cholesterol with severe acute pancreatitis: a U-shaped relationship. Clin Nutr 2020;39:250-257. https://doi.org/10.1016/j.clnu.2019.01.022
  25. Socea B, Bolocan A, Bratu OG, et al. Hypercholesterolemia, as a predictor factor of severe acute pancreatitis. Mod Med 2018;25:219-222. https://doi.org/10.31689/rmm.2018.25.4.219
  26. Hong W, Zimmer V, Stock S, et al. Relationship between low-density lipoprotein cholesterol and severe acute pancreatitis ("the lipid paradox"). Ther Clin Risk Manag 2018;14:981-989. https://doi.org/10.2147/TCRM.S159387
  27. Vihervaara H, Salminen P, Hurme S, et al. Female gender and post-ERCP pancreatitis: is the association caused by difficult cannulation? Scand J Gastroenterol 2011;46:1498-1502. https://doi.org/10.3109/00365521.2011.619275
  28. Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study. Gastrointest Endosc 2001;54:425-434. https://doi.org/10.1067/mge.2001.117550