Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center

Abstract

The double-guidewire technique is a feasible and safe method for difficult biliary cannulation with low rate of post-ERCP pancreatitis. However, it seems important to proceed to alternative cannulation techniques if the double-guidewire technique appears troublesome.

Feasibility of the Novel 3-Step Protocol for Biliary Cannulation—A Prospective Analysis

“…Finally, if all the endoscopic cannulation techniques prove unsuccessful in patients in whom endoscopic diagnosis and therapy are crucial, a rendezvous procedure should definitely be considered. 10 In the current survey, the success rate of the double-guidewire technique for biliary cannulation was 65% and the rate of PEP was 5%; these figures are well in accordance with the earlier literature. The novelty of the present study lies in the inclusion of the double-guidewire technique into the cannulation protocol entity, making the protocol 3-step.…”

“…10 Accordingly, the purpose of the present study was to find out the feasibility and safety of the novel sequential 3-step protocol for deep biliary cannulation (traditional cannula with guidewire, double-guidewire, and needle-knife technique), as tested prospectively by a very experienced ERCP endoscopist. Recently, we analyzed 50 consecutive attempts of double-guidewire-assisted biliary cannulation performed at our institution, and the results were promising.…”

Clinical usefulness of double‐guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography

“…Although SGT has been reported to be useful for difficult biliary cannulation, the usefulness of DGT remains controversial. Studies on the double‐guidewire technique are shown in Table . In the present study, DGT was done only after unsuccessful cannulation with SGT.…”

“…Studies on the double-guidewire technique are shown in Table 8. 6,7,[13][14][15][16] In the present study, DGT was done only after unsuccessful cannulation with SGT. Therefore, the difficulty of the DGT group was greater than that with successful SGT.…”

Female gender and post-ERCP pancreatitis: Is the association caused by difficult cannulation?

“…In this method, the first guidewire is left in the pancreatic duct to physically straighten and occupy it, and a cannula loaded with another guidewire is passed through the working channel alongside the first guidewire and attempted to be introduced into the bile duct. Recently, we reported our experiences of the double-guidewire assisted biliary cannulation [8]. As for the needle-knife assisted cannulation method, we use the so-called needle-knife fistulotomy technique comprised of a short longitudinal incision on the center of the papilla and dorsal aspect of the intramural duct extending, if necessary, towards the neck of the papilla, thus avoiding the area of the papillary orifice [2].…”