A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography

Sallam, Ahmed Elsaid; Alhaddad, Omkolsoum Elsayed; Elsabaawy, Maha Mohamed; Mahmoud, Eman Abdelsameea; Khamis, Ahmed Kamal; Edrees, Ahmed Mohamed

doi:10.21608/aimj.2025.446424

A Randomized Controlled Trial Comparing Different Interventional Techniques for Difficult Common Bile Duct Cannulation in Endoscopic Retrograde Cholangiopancreatography

Document Type : Original Article

Authors

¹ Hepatology and Gastroenterology Mahalla Hepatology Teaching Hospital, General Organization of Teaching Hospitals, Mahalla, AL Gharbia, Egypt

² Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt

10.21608/aimj.2025.446424

Abstract

Background: The gold standard for diagnosing and treating pancreatic-biliary disorders is endoscopic retrograde cholangiopancreatography (ERCP).
Aim: To evaluate the effectiveness of precut and fistulotomy procedures, trans-pancreatic sphincterotomy (TPS), and the double guidewire technique (DGT) in patients with challenging biliary cannulation (DBC).
Patients and Procedures: 150 ERCP candidates with DBC participated in this prospective randomised research. Three groups of patients were randomly assigned: Group I (DGT), Group II (TPS), and Group III (fistulotomy method or needle knife precut).
Results: Out of the 812 patients who were initially enrolled, 622 were able to successfully undergo selective cannulation. The remaining 150 patients were randomized. The success rates of initial and final cannulation were comparable among the three groups (P=0.882), periampullary diverticulum type (P=0.354), successful cannulation both initial and final endoscopic sphincterotomy (P=0.957), first and second cannulation time, hospital stay (P=0.328), cholangitis (P=0.485), bleeding (P=0.107), and post-ERCP (PEP) problems (P=0.151). The only significant difference was less contrast injection in the fistulotomy and precut group (P < 0.005).
Conclusions: With similar success rates, trans-pancreatic sphincterotomy (TPS), precut and fistulotomy, or the double guidewire approach can all be effectively used to handle difficult ERCP cannulation

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