Physician-controlled wire-guided cannulation may improve rates of success in endoscopic retrograde cholangiopancreatography

1. Physician-controlled wire-guided cannulation (PCWGC) in ERCP demonstrated higher success rates and no increased post-ERCP pancreatitis (PEP) rates when used as a second-line cannulation technique, compared to the conventional double-guidewire technique (DGT).

Evidence Rating Level: 2 (Good)

In endoscopic retrograde cholangiopancreatography (ERCP), cannulation of the common bile duct is a common area of challenge for endoscopists. However, overstimulation of the guidewire by an endoscopic assistant can be associated with post-ERCP pancreatitis (PEP). Therefore, a new technique known as physician-controlled wire-guided cannulation (PCWGC) has been developed, to allow endoscopists to control the guidewire without an assistant. This current single-centre retrospective study based in South Korea evaluated ERCP outcomes from using the PCWGC technique. The study population consisted of patients with a naïve ampulla undergoing ERCP. Prior to January 2019, the centre’s conventional strategy for cannulation involved attempting cannulation catheter access first, then switching to the double-guidewire technique (DGT) if the former was unsuccessful, before switching to precut infundibulotomy if DGT was also unsuccessful. After January 2019, the centre’s new strategy replaced DGT with PCWGC as the second-line technique. In total, the study included 536 patients, 281 under the conventional strategy and 255 in the new strategy groups. After propensity matching, there were 219 patients included in each group. The results found similar cannulation success rates (96.8% vs 99.1%) in the conventional and new strategy groups respectively, with no difference in time (p = 0.0779). As well, there was a higher success rate with PCWGC compared to DGT (13.4% vs 4.2%), and shorter cannulation time (131.0 seconds vs 639.7 seconds), with no difference in PEP. In a subgroup of difficult cannulation patients, there was also a higher success rate for PCWGC compared to DGT (78.1% vs 39.1%, p = 0.007) with similar rates of PEP (8.7% vs 13.0%). Overall, this study demonstrated that PCWGC is more effective than conventional second-line techniques for common bile duct cannulation in ERCP, with no difference in complications.

Click to read the study in PLOS

Image: PD

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