Comparing the Efficacy and Safety of Transpancreatic Sphincterotomy, Double-Guidewire, and Precut Techniques: Which One Makes the Cut?

Excerpt

Difficult bile duct cannulation, a commonly encountered and exasperating situation for endoscopists, is often due to obstruction of the bile duct (BD) by an ampullary septum, separating the ducts, which results in repeated entry of the guidewire into the pancreatic duct (PD). Since the risk of post-ERCP pancreatitis (PEP) increases exponentially with repeat guidewire passages into PD [1], this occurrence may be prevented with the use of pancreatic guidewire-assisted methods, including single guidewire methods, the double-guidewire (DGW) technique, and transpancreatic sphincterotomy (TPS) (Fig. 1), all of which may help facilitate BD cannulation in such situations. The limited literature that exists comparing these advanced cannulation techniques mostly includes underpowered studies. The authors Pecsi et al. [2], from Hungary, have previously performed a meta-analysis comparing the success and complication rates of TPS and needle-knife precut papillotomy (NKPP) in patients with difficult biliary access, suggesting the former to have higher success with cannulation and lower bleeding, PEP rates.

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