Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: prospective randomized study.Sugiyama H1, Tsuyuguchi T1, Sakai Y1, Mikata R1, Yasui S1, Watanabe Y1, Sakamoto D1, Nakamura M1, Nishikawa T1. Endoscopy. 2017 Oct 11. [Epub ahead of print]

Background and study aimsDifficult biliary cannulation and unintentional pancreatic duct cannulation are thought to be important contributors to pancreatitis occurring after endoscopic retrograde cholangiopancreatography. Our aim was to compare and evaluate the rates of success and complications of transpancreatic precut papillotomy (TPPP) and the double-guidewire technique (DGT), both with prophylactic pancreatic stenting.

Patients and methodsFrom April 2011 to March 2014, patients with difficult biliary cannulation, in whom we planned to first position a guidewire in the pancreatic duct, were enrolled, and 68 patients were prospectively randomly allocated to two groups (TPPP 34, DGT 34). We evaluated the rates of success and complications for each group. ResultsTPPP had a significantly higher success rate (94.1%) than DGT (58.8%). The rate of post-ERCP pancreatitis was 2.9% in both groups. There was no significant difference between the two groups in the overall rate of complications related to cannulation. ConclusionIf biliary cannulation cannot be achieved, TPPP should be selected first after unintentional pancreatic duct cannulation.

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