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Digestive Diseases and Sciences

, Volume 57, Issue 12, pp 3271–3278 | Cite as

Use of a Pancreatic Duct Stent or Guidewire Facilitates Bile Duct Access with Low Rates of Precut Sphincterotomy: A Randomized Clinical Trial

  • Gregory A. Coté
  • Daniel K. Mullady
  • Sreenivasa S. Jonnalagadda
  • Rajesh N. Keswani
  • Sachin B. Wani
  • Christine E. Hovis
  • Tarek Ammar
  • Abed Al-Lehibi
  • Steven A. Edmundowicz
  • Sri Komanduri
  • Riad R. AzarEmail author
Original Article

Abstract

Background and Study Aims

Among cases of difficult biliary cannulation, alternatives include use of a pancreatic duct stent (PDS) or guidewire (PDW) to facilitate access. We compared the effectiveness of a PDS versus a PDW to facilitate common bile duct (CBD) cannulation.

Patients and Methods

We conducted a randomized, crossover trial at two endoscopy referral centers, limited to patients undergoing ERCP without a history of biliary sphincterotomy. After meeting predefined criteria for difficult cannulation, patients were randomized to using a PDS or PDW to facilitate CBD cannulation. Outcomes included cannulation rate within 6 min, overall cannulation rate, frequency of precut, and complication rates.

Results

Among 442 eligible patients, 87 (19.7 %) met criteria for difficult cannulation. Forty two were randomized to PDW, 54 to PDS (including 9 PDW patients crossed over to PDS). The rate of CBD cannulation within 6 min was similar in the PDW (38.1 %) and PDS (51.9 %) groups (p = 0.18). In a secondary analysis limited to patients who successfully underwent PDW or PDS deployment, the rate was also comparable (PDW 59.3 %, PDS 65.1 %; p = 0.62). The overall frequency of CBD cannulation was 66.7 % in PDW and 90.7 % in PDS patients. Precut was required in 9.5 % of PDW and 25.9 % of PDS patients. Complication rates were similar, with 4 (4.6 %) patients having post-ERCP pancreatitis and 1 (1.1 %) having post-ERCP pain without confirmation of pancreatitis.

Conclusions

Use of a PDS or PDW facilitates CBD cannulation while maintaining a low complication rate and reducing the need for precut sphincterotomy in the majority of cases.

Keywords

Cannulation ERCP Stent Bile duct Endoscopy 

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Gregory A. Coté
    • 1
    • 2
  • Daniel K. Mullady
    • 1
  • Sreenivasa S. Jonnalagadda
    • 1
  • Rajesh N. Keswani
    • 3
  • Sachin B. Wani
    • 1
  • Christine E. Hovis
    • 1
  • Tarek Ammar
    • 1
  • Abed Al-Lehibi
    • 1
  • Steven A. Edmundowicz
    • 1
  • Sri Komanduri
    • 3
  • Riad R. Azar
    • 1
    Email author
  1. 1.Washington University School of Medicine in St. LouisSt. LouisUSA
  2. 2.Indiana University School of MedicineIndianapolisUSA
  3. 3.Northwestern University Feinberg School of MedicineChicagoUSA

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