Use of a Pancreatic Duct Stent or Guidewire Facilitates Bile Duct Access with Low Rates of Precut Sphincterotomy: A Randomized Clinical Trial

Abstract

Use of a PDS or PDW facilitates CBD cannulation while maintaining a low complication rate and reducing the need for precut sphincterotomy in the majority of cases.

Early pancreatic stent placement in wire‐guided biliary cannulation: A multicenter retrospective study

“…In addition, a retrospective study suggests that PS‐WGC can be a salvage technique for cases with difficult biliary cannulation . Considering the increased difficulty in biliary cannulation in cases with a small ampulla during PS‐WGC (the rate of difficult cannulation was 86% within the group), DGW technique, or additional precut sphincterotomy over a pancreatic stent may be an option for these cases …”

“…In PS‐WGC, we can readily place a pancreatic stent and avoid the injury to the pancreatic parenchyma during ERCP. Although the potential effectiveness of PS‐WGC has been reported in terms of biliary cannulation success, there is a paucity of evidence on prevention of PEP …”

“…20 In PS-WGC, we can readily place a pancreatic stent and avoid the injury to the pancreatic parenchyma during ERCP. Although the potential effectiveness of PS-WGC has been reported in terms of biliary cannulation success, [20][21][22][23] there is a paucity of evidence on prevention of PEP. 24 To compare the effectiveness of PS-WGC and repeated WGC, we conducted a retrospective study of patients undergoing ERCP at five tertiary care centers.…”

Difficult Biliary Access

“…However, more precut sphincterotomies were performed with the pancreatic stent-assisted technique (26% vs 10%), likely accounting for the higher cannulation success. 20 A retrospective study of 76 patients showed similar efficacy (93% success, 21% requiring precut). 21 The placement of a pancreatic stent immediately, although helpful for precut, can often compress the biliary orifice and make standard approaches more difficult.…”

Endoscopic retrograde cholangiopancreatography complications: Techniques to reduce risk and management strategies

“…78,79 The risk of PEP (5%) was acceptable with this method while the need for precut sphincterotomy may be increased (> 25%). 80 Needle knife fistulotomy (NKF), whereby the cut is initiated away from the papillary/pancreatic orifice, is perhaps a safer precut method with regard to PEP. 47 A PRCT comparing NKF to NKS reported no cases of PEP after NKF compared to only 7.6% for NKS but one fatality occurred.…”