Comparison between double guidewire technique and transpancreatic sphincterotomy technique for difficult biliary cannulation

Objective\r\nTo compare the efficacy and safety of double guidewire technique (DGT) with transpancreatic sphincterotomy (TPS) in cannulation of difficult biliary.\r\n\r\n\r\nMethods\r\nThe data of patients undergoing endoscopic retrograde cholangiopancreatography from January 2014 to January 2016 in our hospital were retrospectively studied. DGT or TPS was performed on patients with difficult biliary cannulation and frequent unintended pancreatic cannulation. The cannulation success rate, cannulation time and complications of DGT and TPS were compared.\r\n\r\n\r\nResults\r\nData of 237 patients with difficult biliary cannulation were collected, including 135 using DGT and 102 using TPS. The cannulation success rate was 79.3% (107/135) in DGT and 90.2% (92/102) in TPS (P=0.023). The cannulation time was 8.8±2.7 min in DGT and 4.7±1.3 min in TPS (P=0.017). The overall incidence of complications was 8.9% (12/135) in DGT and 8.8% (9/102) in TPS (P=0.986).\r\n\r\n\r\nConclusion\r\nFor patients with difficult biliary cannulation, TPS has higher success rate, shorter cannulation time, and similar complication rate compared with DGT. Endoscopists with skilled TPS procedure could select TPS as a preferred method in difficult biliary cannulation.\r\n\r\n\r\nKey words: \r\nCholangiopancreatography, endoscopic retrograde; Difficult biliary cannulation; Transpancreatic sphincterotomy; Double guidewire technique