Dual-guidewire technique of ERCP in difficult biliary cannulation

Sănătate EVP Medical Center, Chisinau, Republic of MoldovaBackground. Acute pancreatitis (AP) is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), and develops in up to 15% of cases. Difficult biliary cannulation is a recognized technical factor in the development of post-ERCP pancreatitis. Modern technique of ERCP provides the initial cannulation of biliary duct with a small-diameter flexible guidewire with a hydrophilic tip without the use of preliminary contrasting. Purpose. To assess the results of dual-guidewire technique of ERCP for difficult biliary cannulation. Material and methods. The dual-guidewire technique of ERCP, when the pancreatic duct is inadvertently cannulated with a first guidewire, whereas second guidewire is passed alongside the existing wire and manipulated into the common bile duct, used in 11 patients. Eight patients underwent the procedure for choledocholithiasis, and 3 for the purpose of biliary stenting for pancreatic head tumors. Results. The insertion of a second guidewire into the bile ducts was successful and the goal of endoscopic procedure was achieved in all 11 patients. According to the Cotton consensus criteria, mild post-ERCP pancreatitis, defined as the appearance of AP symptoms, associated by blood amylase at least 3 times higher than normal value for more than 24 hours after the procedure, was detected in only 2 (18%) patients. The rest of the patients had an uneventful post-procedural evolution. Conclusions. The dual-wire ERCP technique may be the preferred salvage measure in difficult situations with single-wire biliary cannulation failure, accompanied by a high therapeutic success rate and a low incidence of post-ERCP pancreatitis. However, more extensive future studies are needed to determine definitively its effectiveness