Department of Gastroenterology, Saint Joseph Hospital, Marseille, France.
Department of Gastroenterology, Jacques Lacarin Hospital, Vichy, France.
Endoscopy. 2022 Feb;54(2):120-127. doi: 10.1055/a-1395-7485. Epub 2021 Apr 15.
During endoscopic retrograde cholangiopancreatography (ERCP), access to the common bile duct (CBD) can be problematic after unintentional insertion of the guidewire into the pancreatic duct. We conducted a prospective, randomized study in order to compare biliary cannulation success rates of early double-guidewire (EDG) and repeated single-guidewire (RSG) techniques in patients with inadvertent passage of the guidewire into the pancreatic duct.
Patients with a native papilla were randomly assigned to either the EDG or RSG groups after unintentional insertion of the guidewire into the pancreatic duct. The primary outcome was successful selective CBD cannulation within 10 minutes. The secondary outcomes were successful final selective bile duct cannulation, time to bile duct cannulation, and frequency of post-ERCP pancreatitis (PEP).
142 patients were randomized and selective bile duct cannulation was achieved in 57/68 patients (84 %) in the EDG group and in 37/74 patients (50 %) in the RSG group within 10 minutes (relative risk 1.34; 95 % confidence interval 1.08-6.18; < 0.001). The overall final selective bile duct cannulation rate was 99.3 %. The time to access the CBD was shorter using the EDG technique (6.0 vs. 10.4 minutes; = 0.002). Mild PEP was not observed more frequently in the EDG group than in the RSG group.
The EDG technique significantly increased the success rate of biliary duct cannulation within 10 minutes compared with an RSG approach.
在经内镜逆行胰胆管造影术（ERCP）中，如果导丝意外插入胰管，进入胆总管（CBD）可能会出现问题。我们进行了一项前瞻性、随机研究，以比较意外插入胰管后早期双导丝（EDG）和重复单导丝（RSG）技术在患者中的胆管插管成功率。
导丝意外插入胰管后，将具有天然乳头的患者随机分配到 EDG 或 RSG 组。主要结局是在 10 分钟内成功选择性 CBD 插管。次要结局是最终成功选择性胆管插管、胆管插管时间和 ERCP 后胰腺炎（PEP）的发生率。
142 例患者随机分组，EDG 组 68 例患者中有 57 例（84%）在 10 分钟内成功选择性胆管插管，RSG 组 74 例患者中有 37 例（50%）（相对风险 1.34；95%置信区间 1.08-6.18； ＜0.001）。总体最终选择性胆管插管率为 99.3%。EDG 技术的 CBD 进入时间更短（6.0 分钟 vs. 10.4 分钟； ＝0.002）。EDG 组和 RSG 组轻度 PEP 的发生率无显著差异。
与 RSG 方法相比，EDG 技术可显著提高 10 分钟内胆管插管的成功率。
