Abstract:
Background. Acute pancreatitis (AP) is the most common
complication of endoscopic retrograde
cholangiopancreatography (ERCP), and develops in up to 15% of
cases. Difficult biliary cannulation is a recognized technical factor
in the development of post-ERCP pancreatitis. Modern technique
of ERCP provides the initial cannulation of biliary duct with a
small-diameter flexible guidewire with a hydrophilic tip without
the use of preliminary contrasting.
Purpose. To assess the results of dual-guidewire technique of
ERCP for difficult biliary cannulation.
Material and methods. The dual-guidewire technique of ERCP,
when the pancreatic duct is inadvertently cannulated with a first
guidewire, whereas second guidewire is passed alongside the
existing wire and manipulated into the common bile duct, used in
11 patients. Eight patients underwent the procedure for
choledocholithiasis, and 3 for the purpose of biliary stenting for
pancreatic head tumors.
Results. The insertion of a second guidewire into the bile ducts
was successful and the goal of endoscopic procedure was
achieved in all 11 patients. According to the Cotton consensus
criteria, mild post-ERCP pancreatitis, defined as the appearance
of AP symptoms, associated by blood amylase at least 3 times
higher than normal value for more than 24 hours after the
procedure, was detected in only 2 (18%) patients. The rest of the
patients had an uneventful post-procedural evolution. Conclusions. The dual-wire ERCP technique may be the
preferred salvage measure in difficult situations with single-wire
biliary cannulation failure, accompanied by a high therapeutic
success rate and a low incidence of post-ERCP pancreatitis.
However, more extensive future studies are needed to determine
definitively its effectiveness.
