Comparative Study Of Direct Access With The Sphincterotome And Wire-guided Cannulation In ERCP

BACKGROUND/AIM:In the diagnosis and treatment of biliary tract disease with endoscopic retrograde Cholangiopancreatography(ERCP),selective choledochal intubation is the most critical and decisive step.At present,most of the selective choledochal intubation is Guidewire insertion.There are two methods of the technique,one is Wire-guided Cannulation(WGC)and the other is Direct Access with the Sphincterotome(DAS).Data in the comaparation of the two methods are lacking.The aim of this study was to compare the successful cannulation and complication rate of DAS and WGC in ERCP.PATIENTS AND METHODS:We report a retrospective cohort study comparing DAS(n=68)to WGC(n=90)in a cohort.We reviewed the medical records of 158 patients who underwent ERCP for the first time in the Longyan First Hospital of Fujian Medical University from January 2018 to January 2019.we define the initial intubation success as the catheter successfully enterring the common bile duct within 15 minutes and does not relying on other intubation techniques,such as the double guide wire method,the pancreatic duct stent method,the pre-cut method,and so on.And the repeated intubation.sucess as intubation time more than 15 minutes or by other intubation methods.Comparison of initial intubation success rate,initial intubation time,need for repeated intubation rate,repeated intubation success rate,total intubation success rate,non-subjective entered into pancreatic duct rate,high amylase after ERCP,post-ERCP Pancreatitis(PEP),hemorrhage,and complications.RESULTS:There were different between the two groups in the initial intubation rate,repeated intubation rate and non-subjective entered into pancreatic duct rate(64.7% VS48.9%,P<0.05;35.3%VS51.1%,P<0.05 and 8.8%VS25.6%,P<0.05 in the DAS and WGC group,respectively),and,initial intubation time,repeated intubaion,total intubation success rate,high amylase after ERCP,and PEP were not different between the two groups(5.43±3.01 min vs 6.81±3.52,P>0.05;70.8% vs 80.8%%,P>0.05;91.2%vs92.2%,P>0.05;11.8%vs 15.6%,P>0.05 and 2.9% vs 5.6%,P>0.05 in the DAS and WGC group,respectively).There was one case of bleeding in the DAS group and the WGC group,respectively,all of which were mild hemorrhage;there were no perforation cases in the two groups.CONCLUSIONS:In the ERCP,DAS and WGC are equally effective and safe.But,the initial intubation success rate in DAS may be higher than the WGC group,and DAS needs less repeated intubation.