Biliary Cannulation, Endoscopic Retrograde Cholangiopancreatography
Conditions
Keywords
ERCP, double guidewire technique, learning curve
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 CBD with a sphincterome preloaded with another guidewire often becomes feasible. When performing DWT, a sphincterotome should enter the common duct of papilla through a small orifice and be placed in the left and upper direction of PD guidewire. Then another guidewire can be advanced into bile duct. As an advanced cannulation technique, DWT can be successfully performed in up to 80% of difficult patients. However, it can be technically difficult, especially for trainees or endoscopists without adequate experience. Here we planned to prospectively record the procedures of double-wire cannulation by two trainees without prior experience of DWT. This study aims to delinate the learning curve of DWT and its safety by trainees.
Interventions
PROCEDUREDWT learning curve
trainees learn to perform DWT after unsuccessful initial cannulation
Sponsors
Air Force Military Medical University, China
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18-90 with native papilla * patients with diffcult cannulation of bile duct * Inadvertent pancreatic duct cannulation
Exclusion criteria
* Contraindications of ERCP * Major or minor pancreatic duct as the targeted duct * Prior EST or needle-knife precut before DWT * Surgically altered gastrointestinal anatomy * Papillary carcinoma or stone impaction within papilla * Complete pancreas divisum * Pregnant or breastfeeding women * Unwilling or inability to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Successful cannulation of bile duct within 5min or 5 attempts of cannulation | 3 hours | It was defined by assurance of entering bile duct through cholangiogram during fluoroscopy. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Successful cannulation time with DWT by trainees | 3 hours | Successful cannulation time was defined by the time taken from the begining of DWT to entering bile duct successfully |
| Cannulation attempts with DWT by trainees | 3 hours | One cannulation attempt was defined by touching papilla for more than 5 seconds. |
| Precut rate | 3 hours | Precut includes the procedure of cannulation involving needle knife or dual knife and transpancreatic precut by a sphincterotome. |
| post-ERCP pancreatitis(PEP) | 48 hours | PEP is defined according to Cotton's criteria. The severity classification is based on revised Atlanta criteria. |
| Overall ERCP-related complications | 48 hours | Overall ERCP-related complations include PEP, bleeding, perforation, cholangitis and others, which is defined by Cotton's criteria. |
Countries
China
Outcome results
None listed