Biliary Cannulation, Endoscopic Retrograde Cholangiopancreatography
Conditions
Keywords
ERCP, double guidewire technique
Brief summary
Selective cannulation is considered the most challenging step for most of Endoscopic retrograde cholangiopancreatography (ERCP). Wire-guided cannulation is the standard technique for initial cannulation. When meeting difficulty, double wire technique (DWT) is widely used. With one guidewire occupying pancreatic duct (PD), the following cannulation of common bile duct (CBD) with a sphincterotome preloaded with another guidewire often becomes feasible. However, because of the small opening of the papilla, sometimes it is technically challenging for the following cannulation of CBD with the sphincterotome and PD guidewire in the same working channel. We hypothesized that a tiny cut of the opening of papilla, without the injury of pancreatic sphincter, may facilitate the success of DWT and shorten the overall cannulation time.
Interventions
PROCEDUREModified double wire technique
For experimental arm, a tiny cut of papilla orifice, with the length of 5mm, was performed by sphincterotome before the double wire cannulation.
Sponsors
Air Force Military Medical University, China
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18-90 with native papilla; * CBD as the targeted duct; * Inadvertent PD cannulation more than twice; * Selective biliary cannulation was not possible within 10 minutes or 5 attempts.
Exclusion criteria
* Contraindications of ERCP; * Major or minor PD as the targeted duct; * NK or transpancreatic precut before enrollment ; * Surgically altered GI anatomy; * Papillary carcinoma or stone impaction within papilla or fistula in papilla; * Prior endoscopic sphincterotomy; * Complete pancreas divisum; * failure of pancreatic duct cannulation; * Pregnant or breastfeeding women; * Unwilling or inability to provide consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Success rate of double wire technique | 3 hours | the rate of successful cannulation of CBD for ≤5 attempts by using the sphincterotome alongside the PD guidewire. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| cannulation time of double wire technique | 3 hours | the time taken from the touching of papilla by the sphincterotome alongside the PD guidewire to the successful cannulation of CBD |
| Number of attempts for the successful CBD cannulation | 3 hours | — |
| Overall cannulation success rate | 3 hours | — |
| complication rates | 48 hours | — |
Countries
China
Contacts
Primary ContactPan Yanglin, M.D.
Outcome results
None listed