Application Of Transpancreatic Precut Sphincterotomy Combined With Double Wire-guided Technique In Difficult Biliary Cannulation Of ERCP

Objective To investigate the value of transpancreatic precut sphincterotomy combined with double wire-guided technique in difficult biliary cannulation of endoscopic retrograde cholangiopancreatography(ERCP).Methods The data of 426 patients with difficult biliary cannulation who underwent ERCP at Liaoning Provincial People’s Hospital from January 2017 to January 2023were retrospectively analyzed.According to the different ways of biliary cannulation,patients were divided into the double wire-guided technique group(DWG,113 cases),the transpancreatic precut sphincterotomy group(TPS,89 cases),and the transpancreatic precut sphincterotomy combined with double wire-guided technique group(the combined technique group,22 4 cases).The rate of successful deep biliary cannulation in 15 minutes and without a time limit were observed,as well as the rate of complications developed in the three groups.Results Within 15 minutes,successful deep biliary cannulation was realize in 70/ 113patients(61.9%)in DWG,66/89 patients(74.2%)in TPS and 193/224 patients(86.2%)in the combined technique group.There was a significantly difference in the rate of successful deep biliary cannulation in 15 minutes between the three groups(P < 0.001).The rate of success was significantly higher with the combined technique group than with DGW and TPS(P < 0.001 and P = 0.011).No significantly difference existed in the rate of success in 15 minutes between DWG and TPS(P=0.066).If the time limit is disregarded,the rate of successful deep biliary cannulation was 61.9%(110/ 113)in DWG,97.8%(87/89)in TPS and 98.2%(220/224)in the combined technique group.There was no significantly difference in the rate of final success between the three groups(P =0.905).The PEP rate was 2.7%(3/ 113)in DWG,3.4%(3/89)in TPS and3.6%(8/224)in the combined technique group.No significant difference existed in the three groups in terms of PEP rate or PEP severity(P=0.938).The cholangitis rate was0.9%(1/ 113)in DWG and 0.9%(2/224)in the combined technique group.No cases of cholangitis developed in TPS.There was no significant difference between DWG and the combined technique group in terms of cholangitis severity(P= 1.000).No significantly difference existed in the rate of cholangitis between the three groups(P= 1.000).The bleeding rate was 1.1%(1/89)in TPS and 0.4%(1/224)in the combined technique group.No cases of bleeding occurred in DWG.There was no significant difference between TPS and the combined technique group in terms of bleeding severity(P=0.4 8 8).No significantly difference existed in the bleeding rate between the three groups(P =0.444).The perforation rate was 0.4%(1/224)in the combined technique group.No cases of perforation developed in DWG and TPS.There was no significant difference between the three groups in terms of perforation rate(P= 1.000).The total complications rate was 3.5%(4/ 113)in DWG,4.5%(4/89)in TPS and 5.4%(12/224)in the combined technique group.No significant difference existed in the three groups in terms of total complications rate(P=0.790).Conclusion In terms of difficult biliary cannulation of ERCP,the combined technique has higher cannulation efficiency and similar final success rate compared with DWG and TPS in the hands of experts.In the case of prophylactic pancreatic stenting,the combined technique also has a high level of security to be recommended as a valuable assistant technology in clinical application.