Use of a pancreatic duct stent or guidewire facilitates bile duct access with low rates of precut sphincterotomy: A randomized clinical trial

Gregory A. Coté, Daniel K. Mullady, Sreenivasa S. Jonnalagadda, Rajesh N Keswani, Sachin B. Wani, Christine E. Hovis, Tarek Ammar, Abed Al-Lehibi, Steven A. Edmundowicz, Srinadh Komanduri, Riad R. Azar*

*Corresponding author for this work

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background and Study Aims: Among cases of difficult biliary cannulation, alternatives include use of a pancreatic duct stent (PDS) or guidewire (PDW) to facilitate access. We compared the effectiveness of a PDS versus a PDW to facilitate common bile duct (CBD) cannulation. Patients and Methods: We conducted a randomized, crossover trial at two endoscopy referral centers, limited to patients undergoing ERCP without a history of biliary sphincterotomy. After meeting predefined criteria for difficult cannulation, patients were randomized to using a PDS or PDW to facilitate CBD cannulation. Outcomes included cannulation rate within 6 min, overall cannulation rate, frequency of precut, and complication rates. Results: Among 442 eligible patients, 87 (19.7 %) met criteria for difficult cannulation. Forty two were randomized to PDW, 54 to PDS (including 9 PDW patients crossed over to PDS). The rate of CBD cannulation within 6 min was similar in the PDW (38.1 %) and PDS (51.9 %) groups (p = 0.18). In a secondary analysis limited to patients who successfully underwent PDW or PDS deployment, the rate was also comparable (PDW 59.3 %, PDS 65.1 %; p = 0.62). The overall frequency of CBD cannulation was 66.7 % in PDW and 90.7 % in PDS patients. Precut was required in 9.5 % of PDW and 25.9 % of PDS patients. Complication rates were similar, with 4 (4.6 %) patients having post-ERCP pancreatitis and 1 (1.1 %) having post-ERCP pain without confirmation of pancreatitis. Conclusions: Use of a PDS or PDW facilitates CBD cannulation while maintaining a low complication rate and reducing the need for precut sphincterotomy in the majority of cases.

Original languageEnglish (US)
Pages (from-to)3271-3278
Number of pages8
JournalDigestive diseases and sciences
Volume57
Issue number12
DOIs
StatePublished - Dec 1 2012

Keywords

  • Bile duct
  • Cannulation
  • ERCP
  • Endoscopy
  • Stent

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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