Transpancreatic precut papillotomy versus double-guidewire technique in difficult biliary cannulation: prospective randomized study

Background and study aims Difficult biliary cannulation and unintentional pancreatic duct cannulation are thought to be important contributors to pancreatitis occurring after endoscopic retrograde cholangiopancreatography. Our aim was to compare and evaluate the rates of success and complications of transpancreatic precut papillotomy (TPPP) and the double-guidewire technique (DGT), both with prophylactic pancreatic stenting. Patients and methods From April 2011 to March 2014, patients with difficult biliary cannulation, in whom we planned to first position a guidewire in the pancreatic duct, were enrolled, and 68 patients were prospectively randomly allocated to two groups (TPPP 34, DGT 34). We evaluated the rates of success and complications for each group. Results TPPP had a significantly higher success rate (94.1%) than DGT (58.8%). The rate of post-ERCP pancreatitis was 2.9% in both groups. There was no significant difference between the two groups in the overall rate of complications related to cannulation. Conclusion If biliary cannulation cannot be achieved, TPPP should be selected first after unintentional pancreatic duct cannulation. University Hospital Medical Network Clinical Trials Registry UMIN 000008200 TRIAL REGISTRATION: Prospective randomized study UMIN 000008200 at http://www.umin.ac.jp