Abstract：
BACKGROUND: When unintentional pancreatic duct access occurs during difficult biliary cannulation, the double guidewire (DGW) or transpancreatic sphincterotomy (TPS) may be utilized. DGW can be easily switched to TPS due to the existing guidewire in the pancreatic duct. However, the efficacy of TPS after DGW, named sequential DGW-TPS technique, versus primary TPS has not been assessed.
OBJECTIVE: Our aim was to compare the benefits and adverse events of sequential DGW-TPS technique and primary TPS.
METHODS: We performed a comparative retrospective cohort study that enrolled a total of 117 patients with native papillae. The patients were divided into one of 2 groups according to the primary bile duct access technique (sequential DGW-TPS or primary TPS), both with pancreatic stenting.
RESULTS: Between November 2017 and May 2023, a total of 84 patients were grouped into sequential DGW-TPS and 33 into primary TPS. The overall post-ERCP pancreatitis (PEP) rate was 4.3% in the entire cohort, with no statistical differences were observed between the groups in terms of PEP rates (P = 0.927), PEP severity (P = 1.000), first biliary cannulation success (P = 0.621), overall cannulation success (P = 1.000), hyperamylasemia incidence (P = 0.241), elevated amylase levels (P = 0.881), and postoperative hospital stay (P = 0.185). Furthermore, these results remained consistent in multivariable regression analysis.
CONCLUSIONS: The sequential DGW-TPS technique showed a comparable safety and biliary cannulation success rate to primary TPS in difficult biliary cannulation. Given the potential long-term complications associated with TPS, DGW should be first if inadvertent pancreatic access occurs, with TPS serving as second only if DGW fails.
OBJECTIVE: Our aim was to compare the benefits and adverse events of sequential DGW-TPS technique and primary TPS.
METHODS: We performed a comparative retrospective cohort study that enrolled a total of 117 patients with native papillae. The patients were divided into one of 2 groups according to the primary bile duct access technique (sequential DGW-TPS or primary TPS), both with pancreatic stenting.
RESULTS: Between November 2017 and May 2023, a total of 84 patients were grouped into sequential DGW-TPS and 33 into primary TPS. The overall post-ERCP pancreatitis (PEP) rate was 4.3% in the entire cohort, with no statistical differences were observed between the groups in terms of PEP rates (P = 0.927), PEP severity (P = 1.000), first biliary cannulation success (P = 0.621), overall cannulation success (P = 1.000), hyperamylasemia incidence (P = 0.241), elevated amylase levels (P = 0.881), and postoperative hospital stay (P = 0.185). Furthermore, these results remained consistent in multivariable regression analysis.
CONCLUSIONS: The sequential DGW-TPS technique showed a comparable safety and biliary cannulation success rate to primary TPS in difficult biliary cannulation. Given the potential long-term complications associated with TPS, DGW should be first if inadvertent pancreatic access occurs, with TPS serving as second only if DGW fails.
摘要：
背景：当在困难的胆道插管期间发生意外胰管进入时，可以利用双导丝(DGW)或经胰腺括约肌切开术(TPS)。由于胰管中存在导丝，DGW可以轻松切换到TPS。然而,DGW后TPS的功效，称为顺序DGW-TPS技术，与主要TPS相比，尚未评估。
目的：我们的目的是比较序贯DGW-TPS技术和主要TPS的益处和不良事件。
方法：我们进行了一项比较回顾性队列研究，共纳入117例天然乳头患者。根据原发性胆管通路技术(序贯DGW-TPS或原发性TPS)将患者分为2组,两者都有胰腺支架置入术。
结果：在2017年11月至2023年5月之间，共有84名患者被分为序贯DGW-TPS，33名患者被分为主要TPS。在整个队列中，ERCP术后胰腺炎（PEP）的总发生率为4.3%，两组之间的PEP率无统计学差异（P=0.927），PEP严重程度（P=1.000），首次胆道插管成功(P=0.621),插管总成功率(P=1.000),高淀粉酶血症发生率(P=0.241),淀粉酶水平升高（P=0.881），术后住院时间(P=0.185)。此外，这些结果在多变量回归分析中保持一致.
结论：序贯DGW-TPS技术在困难的胆道插管中显示出与原发性TPS相当的安全性和胆道插管成功率。鉴于与TPS相关的潜在长期并发症，如果发生无意的胰腺接入，DGW应该是第一个，只有当DGW出现故障时，TPS才作为第二。
目的：我们的目的是比较序贯DGW-TPS技术和主要TPS的益处和不良事件。
方法：我们进行了一项比较回顾性队列研究，共纳入117例天然乳头患者。根据原发性胆管通路技术(序贯DGW-TPS或原发性TPS)将患者分为2组,两者都有胰腺支架置入术。
结果：在2017年11月至2023年5月之间，共有84名患者被分为序贯DGW-TPS，33名患者被分为主要TPS。在整个队列中，ERCP术后胰腺炎（PEP）的总发生率为4.3%，两组之间的PEP率无统计学差异（P=0.927），PEP严重程度（P=1.000），首次胆道插管成功(P=0.621),插管总成功率(P=1.000),高淀粉酶血症发生率(P=0.241),淀粉酶水平升高（P=0.881），术后住院时间(P=0.185)。此外，这些结果在多变量回归分析中保持一致.
结论：序贯DGW-TPS技术在困难的胆道插管中显示出与原发性TPS相当的安全性和胆道插管成功率。鉴于与TPS相关的潜在长期并发症，如果发生无意的胰腺接入，DGW应该是第一个，只有当DGW出现故障时，TPS才作为第二。
