Skip to main content
SpringerLink
Log in

Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video)

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has been reported to be effective for patients with surgically altered gastrointestinal anatomy. However, selective biliary cannulation remains difficult in BE-ERCP. We examined the usefulness of a modified double-guidewire technique using an uneven double lumen cannula (the uneven method) for BE-ERCP in patients with surgically altered gastrointestinal anatomy.

Methods

To clarify the usefulness of the uneven method for selective biliary cannulation in BE-ERCP in comparison to the pancreatic guidewire (PGW) method, 40 patients with surgically altered gastrointestinal anatomy who underwent BE-ERCP with successful placement of a guidewire in the pancreatic duct were evaluated. The uneven method was used in 18 cases (uneven group) and the PGW method was used in the remaining 22 cases (PGW group).

Results

The technical success rate of biliary cannulation was higher in the uneven group than in the PGW group (83.3 vs. 59.0%; P = 0.165). In addition, the time to biliary cannulation were significantly shorter in the uneven group than in the PGW group (6 vs. 18 min; P = 0.004; respectively). In the PGW group, post-ERCP pancreatitis (PEP) occurred in 3 of 22 cases (13.6%). No adverse events, including PEP, occurred in the uneven group.

Conclusions

The uneven method may be a useful option of selective biliary cannulation in BE-ERCP for the patients with surgically altered gastrointestinal anatomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ishii K, Itoi T, Tonozuka R, Itokawa F, Sofuni A, Tsuchiya T et al (2016) Balloon enteroscopy-assisted ERCP in patients with Roux-en-Y gastrectomy and intact papillae (with videos). Gastrointest Endosc 83(2):37786.e6

    Article  Google Scholar 

  2. Itoi T, Ishii K, Sofuni A, Itokawa F, Tsuchiya T, Kurihara T et al (2010) Single-balloon enteroscopy-assisted ERCP in patients with Billroth II gastrectomy or Roux-en-Y anastomosis (with video). Am J Gastroenterol 105(1):93–99

    Article  Google Scholar 

  3. Nakai Y, Kogure H, Yamada A, Isayama H, Koike K (2018) Endoscopic management of bile duct stones in patients with surgically altered anatomy. Dig Endosc 30(Suppl 1):67–74

    Article  Google Scholar 

  4. Yane K, Hayashi T, Katanuma A (2018) Successful emergency endoscopic drainage for afferent limb syndrome-induced severe acute cholangitis in a patient with altered Roux-en Y anatomy. Dig Endosc 30(6):802–803

    Article  Google Scholar 

  5. Dumonceau JM, Deviere J, Cremer M (1998) A new method of achieving deep cannulation of the common bile duct during endoscopic retrograde cholangiopancreatography. Endoscopy 30(7):S80

    Article  CAS  Google Scholar 

  6. Draganov P, Devonshire DA, Cunningham JT (2005) A new technique to assist in difficult bile duct cannulation at the time of endoscopic retrograde cholangiopancreatography. JSLS 9(2):218–221

    PubMed  PubMed Central  Google Scholar 

  7. Gronroos JM, Vihervaara H, Gullichsen R, Laine S, Karvonen J, Salminen P (2011) Double-guidewire-assisted biliary cannulation: experiences from a single tertiary referral center. Surg Endosc 25(5):1599–1602

    Article  Google Scholar 

  8. Herreros de Tejada A, Calleja JL, Diaz G, Pertejo V, Espinel J, Cacho G et al (2009) Double-guidewire technique for difficult bile duct cannulation: a multicenter randomized, controlled trial. Gastrointest Endosc 70(4):700–709

    Article  Google Scholar 

  9. Ito K, Fujita N, Noda Y, Kobayashi G, Obana T, Horaguchi J et al (2008) Pancreatic guidewire placement for achieving selective biliary cannulation during endoscopic retrograde cholangio-pancreatography. World J Gastroenterol 14(36):5595–5600 discussion 9

    Article  Google Scholar 

  10. Ito K, Horaguchi J, Fujita N, Noda Y, Kobayashi G, Koshita S et al (2014) Clinical usefulness of double-guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography. Dig Endosc 26(3):442–449

    Article  Google Scholar 

  11. Maeda S, Hayashi H, Hosokawa O, Dohden K, Hattori M, Morita M et al (2003) Prospective randomized pilot trial of selective biliary cannulation using pancreatic guide-wire placement. Endoscopy 35(9):721–724

    Article  CAS  Google Scholar 

  12. Sasahira N, Kawakami H, Isayama H, Uchino R, Nakai Y, Ito Y et al (2015) Early use of double-guidewire technique to facilitate selective bile duct cannulation: the multicenter randomized controlled EDUCATION trial. Endoscopy 47(5):421–429

    Article  Google Scholar 

  13. Tanaka R, Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T et al (2013) Is the double-guidewire technique superior to the pancreatic duct guidewire technique in cases of pancreatic duct opacification? J Gastroenterol Hepatol 28(11):1787–1793

    Article  Google Scholar 

  14. Xinopoulos D, Bassioukas SP, Kypreos D, Korkolis D, Scorilas A, Mavridis K et al (2011) Pancreatic duct guidewire placement for biliary cannulation in a single-session therapeutic ERCP. World J Gastroenterol 17(15):1989–1995

    Article  Google Scholar 

  15. Takenaka M, Arisaka Y, Sakai A, Kobayashi T, Shiomi H, Masuda A et al (2018) A novel biliary cannulation method for difficult cannulation cases using a unique, uneven, double-lumen cannula (Uneven method). Endoscopy 50(8):E229–E230

    Article  Google Scholar 

  16. Shimatani M, Takaoka M, Okazaki K (2018) Tips for endoscopic stone extraction using new short-type double balloon endoscope for common bile duct stones in patients with surgically altered gastrointestinal anatomy. Dig Endosc 30(1):130–131

    Article  Google Scholar 

  17. Takenaka M, Yamao K, Kudo M (2018) A novel method of biliary cannulation for patients with Roux-en-Y anastomosis using a unique, uneven, double lumen cannula (Uneven method). Dig Endosc 30(6):808–809

    Article  Google Scholar 

  18. Takenaka M, Minaga K, Kudo M (2018) Cannulation method for intradiverticular papilla with long oral protrusion using biopsy forceps for axis alignment. Dig Endosc 30(5):700–701

    Article  Google Scholar 

  19. Cotton PB, Burney PG, Mason RR (1979) Transnasal bile duct catheterisation after endoscopic sphincterotomy: method for biliary drainage, perfusion, and sequential cholangiography. Gut 20(4):285–287

    Article  CAS  Google Scholar 

  20. Dumonceau JM, Andriulli A, Elmunzer BJ, Mariani A, Meister T, Deviere J et al (2014) Prophylaxis of post-ERCP pancreatitis: european Society of Gastrointestinal Endoscopy (ESGE) guideline—updated June 2014. Endoscopy 46(9):799–815

    Article  Google Scholar 

  21. Nakai Y, Isayama H, Sasahira N, Kogure H, Sasaki T, Yamamoto N et al (2015) Risk factors for post-ERCP pancreatitis in wire-guided cannulation for therapeutic biliary ERCP. Gastrointest Endosc 81(1):119–126

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan

    Mamoru Takenaka, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Yoriaki Komeda, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida & Masatoshi Kudo

  2. Division of Biostatistics, Clinical Research Center, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan

    Yasutaka Chiba

  3. Department of Gastroenterology, Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea

    Chang-Il Kwon

  4. Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea

    Seok Jeong

  5. Division of Gastroenterology & Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea

    Tae Hoon Lee

Authors
  1. Mamoru Takenaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kosuke Minaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ken Kamata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kentaro Yamao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoe Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rei Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ayana Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomohiro Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Atsushi Nakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shunsuke Omoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoriaki Komeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Toshiharu Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tomohiro Watanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Naoshi Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yasutaka Chiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Chang-Il Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Seok Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Tae Hoon Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Masatoshi Kudo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MT: manuscript drafting, study conception and design, performing ERCP. KM, KK, KY, TY, RI, AO, TY, AN, and SO: performing ERCP and contribution to writing and revising the manuscript. YC: performing statistical analysis of data. YK, TS, TW, NNi, CK, SJ, and TL: contribution to writing and revising the manuscript. MK: Final approvement of submission

Corresponding author

Correspondence to Mamoru Takenaka.

Ethics declarations

Disclosures

Mamoru Takenaka, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Yoriaki Komeda, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Yasutaka Chiba, Chang-Il Kwon, Seok Jeong, Tae Hoon Lee, and Masatoshi Kudo have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

This video shows how to perform modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy depending on the two situations (“axis matched” and “lumen-replaced”) in detail. Supplementary material 1 (MP4 227604 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takenaka, M., Minaga, K., Kamata, K. et al. Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video). Surg Endosc 34, 1432–1441 (2020). https://doi.org/10.1007/s00464-019-07228-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-019-07228-5

Keywords

Search

Navigation