Comparison of preferred double guidewire technique and transpancreatic sphincterotomy for difficult biliary cannulation

In patients with a naïve papilla, successful biliary cannulation is crucial for performing endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to evaluate the success rate and outcomes of biliary cannulation using the preferred double guidewire technique (DGT). Over a 5.5-year period, patients who underwent the pancreatic guidewire technique were retrospectively analyzed. They were categorized into two groups based on the primary method used for bile duct access: the preferred DGT or the preferred transpancreatic sphincterotomy (TPS). Of the 625 patients who underwent a pancreatic guidewire-assisted technique, 592 were treated with the preferred DGT for common bile duct (CBD) access, while 33 underwent the preferred TPS. Selective CBD approach was achieved on the first attempt in 503 patients (85.0%) in the preferred DGT group and 28 patients (84.8%) in the preferred TPS group (OR 1.01, 95% CI 0.38-2.68; P = 1.000). Ultimately, CBD access was obtained in 587 patients (99.2%) in the preferred DGT group and all 33 patients (100%) in the preferred TPS group (OR 0.00, 95% CI 0.00, Inf; P = 1.000). There were no significant differences in the rates of adverse events (AEs) between the two groups, including post-ERCP pancreatitis (PEP), hemorrhage, cholangitis, and perforation. The preferred DGT proved to be a safe and effective advanced technique for difficult biliary cannulation, reducing the risk of potential long-term complications associated with TPS.