The Application Of Several Assisted Catheterizations In Difficult Selective Biliary Cannulation Of ERCP

Objective To evaluate the effectiveness and post-ERCP complications of several assisted catheterizations in difficult selective biliary cannulation of endoscopic retrograde cholangiopancreatography.Methods A total of 1336 cases in endoscopic retrograde cholangio-pancreatography were chosen from June 2012 to May 2015 including difficult selective biliary cannulation, compare the success rates and complication rates of double guide wire technique, precut sphincterotomy, double guide wire technique combine precut sphincterotomy, ERCP combine percutaneous transhepatic cholangial drainage.Results During the period, the success rate of standard bile duct cannulation was 90.27%(1206/1336). A total of 130 cases were dillicult selective biliary cannulation(9.73%,130/1336), then 95 cases received assisted catheterizations and 64 cases succeed(67.37%,64/95). The total success rate increased to 95.06%(1270/1336, X2=22.552, P<0.05). Biliary cannulation was successful in 22 of the 32(68.75%) patients in double guide wire group and in 38 of the 55(69.09%) patients in precut sphincterotomy group. Success rates in the two groups did not differ significantly(x2=0.001, P>0.05).Successful cannulation rates in double guide wire technique combine precut sphincterotomy group and ERCP combine percutaneous transhepatic cholangial drainage group were 100%(2/2) and 33.33%(2/6). Complication rate of the total cases was 16.32%(218/1336) including 61 post-ERCP pancreatitis and 15.55%(193/1241) in standard cannulation group including 54 post-ERCP pancreatitis, whereas in the assisted catheterization group, the complication rate was 26.32%(25/95) that including 7 post-ERCP pancreatitis. Complication rates of double guide wire group(10/32) and precut sphincterotomy group(13/55) did not differ significantly(31.25% vs 23.64%,.P>0.05). But compared with standard group, the complication rate of double guide wire group was higher(x2=5.735, P<0.05) when precut sphincterotomy group did not differ significantly(x2=2.575, P>0.05). Complication rates in double guide wire technique combine precut sphincterotomy group and ERCP combine percutaneous transhepatic cholangial drainage group were 50%(1/2) and 16.67%(1/6). PEP rates of standard group, double guide wire group and precut sphincterotomy group did not differ significantly(P>0.05). There was no serious complication such as perforation in either group.Conclusions The several assisted catheterization techniques could increase the success rate of difficult selective biliary cannulation in endoscopic retrograde cholangiopancreatography. The success rate of double guide wire group was similar to precut sphincterotomy group. Compared with standard group, the complication rate of double guide wire group was higher. PEP rates of standard group, double guide wire group and precut sphincterotomy group were similar with each other.