Endoscopy 2021; 53(10): 1011-1019
DOI: 10.1055/a-1327-2025
Original article

Transpancreatic biliary sphincterotomy versus double guidewire in difficult biliary cannulation: a randomized controlled trial

Leena Kylänpää
1  Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
1  Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Arto Saarela
2  Department of Gastrointestinal Surgery, Oulu University Hospital, Oulu, Finland
,
Per Ejstrud
3  Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark
,
Marianne Udd
1  Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Outi Lindström
1  Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Mia Rainio
1  Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Andrea Tenca
4  Abdominal Center, Gastroenterology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Jorma Halttunen
1  Abdominal Center, Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
,
Gunnar Qvigstad
5  Department of Gastroenterology and Hepatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
,
Urban Arnelo
6  Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden
,
Niklas Fagerström
6  Department of Upper Gastrointestinal Diseases, Karolinska University Hospital, Stockholm, Sweden
,
Truls Hauge
7  Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
,
Lars Aabakken
8  Department of Medical Gastroenterology, Rikshospitalet University Hospital, Oslo, Norway
,
Juha Grönroos
9  Division of Digestive Surgery and Urology, Turku University Hospital and University of Turku, Turku, Finland
› Author Affiliations
Supported by: Maud Kuistilan Muistosäätiö 2019-0366F
Supported by: Suomen Lääketieteen Säätiö 1862/2018

https://clinicaltrials.gov Registration number (trial ID): NCT02548884 Type of study: Randomized, multicenter study

Abstract

Background Difficult biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP) increases the risk of post-ERCP pancreatitis (PEP). The purpose of this prospective, randomized, multicenter study was to compare two advanced rescue methods, transpancreatic biliary sphincterotomy (TPBS) and a double-guidewire (DGW) technique, in difficult common bile duct (CBD) cannulation.

Methods Patients with native papilla and planned CBD cannulation were recruited at eight Scandinavian hospitals. An experienced endoscopist attempted CBD cannulation with wire-guided cannulation. If the procedure fulfilled the definition of difficult cannulation and a guidewire entered the pancreatic duct, randomization to either TPBS or to DGW was performed. If the randomized method failed, any method available was performed. The primary end point was the frequency of PEP and the secondary end points included successful cannulation with the randomized method.

Results In total, 1190 patients were recruited and 203 (17.1 %) were randomized according to the study protocol (TPBS 104 and DGW 99). PEP developed in 14/104 patients (13.5 %) in the TPBS group and 16/99 patients (16.2 %) in the DGW group (P = 0.69). No difference existed in PEP severity between the groups. The rate of successful deep biliary cannulation was significantly higher with TPBS (84.6 % [88/104]) than with DGW (69.7 % [69/99]; P = 0.01).

Conclusions In difficult biliary cannulation, there was no difference in PEP rate between TPBS and DGW techniques. TPBS is a good alternative in cases of difficult cannulation when the guidewire is in the pancreatic duct.

Table 1s, Fig. 1s–3s



Publication History

Received: 17 May 2020

Accepted after revision: 27 October 2020

Publication Date:
13 January 2021 (online)

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