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A new guidewire cannulation technique in ERCP: successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist

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Abstract

Background

Current studies have addressed ways to improve the success of selective biliary cannulation in endoscopic retrograde cholangiopancreatography (ERCP). The objective of this study was to assess the efficacy of deep bile duct access using a short-wire system with sphincterotome and guidewire controlled only by the endoscopist.

Methods

This was a prospective study of 70 patients with biliary diseases subjected to ERCP. Biliary cannulation was performed by the endoscopist without direct cooperation of the assistant in two centers with different experience in ERCP. The RX Biliary System™ was used in all patients. Efficacy (success rate and time to cannulation) of deep bile duct access and procedure-related complications were determined.

Results

Overall guidewire cannulation was successful in 65 of 70 patients (92.9%). Nonintentional pancreatic duct cannulation with the guidewire was performed in 22 patients (31.4%). Additional techniques were needed in 18 patients (25.7%): guidewire into the pancreatic duct in 11 patients (15.7%); contrast-medium was used in 13 patients (18.6%); and precut was performed in 3 patients (4.3%). Attempts at papilla cannulation numbered <10 in 48 patients (68.6%), and time to biliary cannulation was <10 min in 42 patients (60%). Minor complications occurred in five patients (7.1%). There were no significant differences between patients in both centers.

Conclusions

The short-wire system allows the endoscopist to have access to the bile duct with a high success rate—early and safely—without the direct participation of the assistant.

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Disclosures

Drs. Antonio López, Isabel Ferrer, Rosa Ana Villagrasa, Inmaculada Ortiz, Nuria Maroto, Cristina Montón, Joaquín Hinojosa, and Eduardo Moreno-Osset have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Gastroenterology Department, Manises Hospital, Universidad Católica de Valencia, C/Roses s/n. 46940 Manises, Valencia, Spain

    Antonio López, Isabel Ferrer, Rosa Ana Villagrasa, Nuria Maroto, Cristina Montón & Joaquín Hinojosa

  2. Gastroenterology Department, Dr. Peset University Hospital, University of Valencia, Valencia, Spain

    Inmaculada Ortiz & Eduardo Moreno-Osset

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  1. Antonio López
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  2. Isabel Ferrer
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Correspondence to Antonio López.

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López, A., Ferrer, I., Villagrasa, R.A. et al. A new guidewire cannulation technique in ERCP: successful deep biliary access with triple-lumen sphincterotome and guidewire controlled by the endoscopist. Surg Endosc 25, 1876–1882 (2011). https://doi.org/10.1007/s00464-010-1479-y

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  • DOI: https://doi.org/10.1007/s00464-010-1479-y

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